Superior vena cava thrombosis has a potential to result in superior vena cava syndrome (SVCS). SVCS is a well-known disorder that stems from the obstruction of the superior vena cava. By far, the most common cause of SVCS are malignancies - carcinomas of the lungs, lymphoma, mediastinal tumors, or metastatic deposits [1] [2] [3] [4] [5] [6]. Thrombotic events in the superior vena cava constitute the significant proportion of the remaining SVCS cases [1] [4]. The presence of indwelling intravascular devices is the main predisposing factor to superior vena cava thrombosis [1] [2]. In fact, virtually any condition that causes mechanical obstruction of blood flow through this vessel can have prothrombotic effects [2]. The clinical presentation of superior vena cava thrombosis focuses on the head and neck area, with main complaints being a sense of head fullness accompanied by flushing and swelling of the face and neck [3] [4] [7]. Respiratory manifestations such as dyspnea and stridor are not uncommon, particularly when thrombosis develops suddenly [4] [8]. Other findings include prominent dilation of veins on the neck, the trunk, and the upper extremities, cyanosis, and neurological deficits [4]. Embolization is a rare but important and possibly life-threatening complication that may occur in superior vena cava thrombosis [2] [7].

• Internal Bleeding

  Thrombolysis with rt-PA was not associated with cutaneous or internal bleeding and was partially effective (improvement of the clinical picture, disappearance of the right atrium thrombus, superior vena cava still occluded). [ncbi.nlm.nih.gov]

• Vascular Disease

  You are more likely to have vascular disease as you get older. [icdlist.com]

  Continued Other Vascular Diseases Your circulatory system is made up of the vessels that carry blood to every part of your body. Vascular disease includes any condition that affects your circulatory system. [webmd.com]

  Signs and symptoms include a nonproductive cough, breathing difficulty, cyanosis, central nervous system disorders, and edema of the conjunctiva, trachea, and esophagus. superior vena cava syndrome Superior vena cava obstruction, SVC obstruction Vascular [medical-dictionary.thefreedictionary.com]

  VASCULAR DISEASE MANAGEMENT 2017;14(7):E157-E159. [vasculardiseasemanagement.com]

  Nonmalignant causes include mediastinal fibrosis; vascular diseases (eg, aortic aneurysm, large-vessel vasculitis); infections such as histoplasmosis, tuberculosis, syphilis, and actinomycosis; benign mediastinal tumors such as teratoma, cystic hygroma [mdedge.com]

• Morning Stiffness

  He was also giving history of morning stiffness. For past 8 months to one year he developed dyspnoea on exertion and swelling over face, neck and anterior chest region ( Figure 1). [romj.org]

• Acne Vulgaris

  In the follow-up, the patient developed recurrent, painful orogenital ulcers and acne vulgaris-like skin eruptions. HLA tissue typing was HLA B-51. The diagnosis of Crohn's disease associated with Behçet's disease was made. [ncbi.nlm.nih.gov]

• Lip Edema

  Unfractionated heparin infusion was started with improvement in her facial and lip edema. Figure 1: Active dermatomyositis. Figure 2: CT chest showing superior vena cava (SVC). [criticalcare.imedpub.com]

  edema, nasal obstruction or epistaxis 2 Facial edema 1 Vessel dilation Neck, face or arms 1 Imaging Chest imaging is an important diagnostic tool that can frequently be used to find the abnormality underlying SVCS (Lacout et al. 2012 ). 84 % of SVCS [springerplus.springeropen.com]

• Head and Neck Swelling

  Common clinical signs are head and neck swelling (97%); large chest wall collaterals (91%); facial cyanosis (56%); arm swelling (53%) and pleural effusions (6%) [13]. Headaches and syncope are from cerebral edema from venous hypertension. [ctsnet.org]

• Communicating Hydrocephalus

  Abstract The authors report an unusual case of superior vena cava thrombosis in an infant who subsequently developed communicating hydrocephalus; they also review previously reported cases of dural sinus hypertension, and separate them into two groups [ncbi.nlm.nih.gov]

• Agitation

  Agitated saline solution injected through the catheter could also have helped complete the diagnosis. However, we chose to avoid this maneuver given we might have dislodged emboli during the infusion. [revespcardiol.org]

A thorough clinical and imaging assessment is necessary to make the diagnosis of superior vena cava thrombosis. A properly obtained patient history can point to an existing condition that could predispose to the symptoms observed during the physical examination. Furthermore, a localized head and neck symptomatology with distended venous vessels are highly suggestive of an ongoing process in the superior vena cava, especially in the presence of a central venous catheter. When clinical suspicion is raised, imaging studies should be employed as soon as possible. Until recently, conventional venography was the gold standard for the evaluation of superior vena cava pathology [5] [6] [8]. The necessity for non-invasive and more sophisticated methods has resulted in the replacement of conventional venography with computed tomography (CT) and magnetic resonance imaging (MRI) [1] [8]. In fact, multidetector CT (MDCT) is able to delineate the exact changes occurring in this vessel and is sufficient to make the diagnosis of superior vena cava thrombosis. Moreover, it also obtains crucial information for choosing the optimal therapeutic approach [1]. In addition, CT and MRI angiography are described as potentially useful studies [5].

• Mural Thrombus

  This is the first case report to our knowledge of superior vena cava syndrome and lethal, massive pulmonary embolus associated with a noniatrogenic right atrial mural thrombus. [ncbi.nlm.nih.gov]

• Liver Biopsy

  A transjugular liver biopsy needle was passed through a vascular sheath in the right internal jugular vein and advanced into the right atrium by pushing through the SVC obstruction. [adc.bmj.com]

1. Sheth S, Ebert MD, Fishman EK. Superior vena cava obstruction evaluation with MDCT. AJR Am J Roentgenol. 2010;194(4):W336-346.
2. Lepper PM, Ott SR, Hoppe H, et al. Superior vena cava syndrome in thoracic malignancies. Respir Care. 2011;56(5):653-666.
3. Otten TR, Stein PD, Patel KC, Mustafa S, Silbergleit A. Thromboembolic disease involving the superior vena cava and brachiocephalic veins. Chest.2003;123(3):809-812.
4. Nunnelee JD. Superior vena cava syndrome. J Vasc Nurs. 2007;25(1):2-5.
5. Santra A, Nandi S, Mondal S, Chakraborty S. Superior Vena Cava Syndrome due to Thrombosis: A Rare Paraneoplastic Presentation of Bronchogenic Carcinoma. Iran J Med Sci. 2016;41(4):354-358.
6. Shaikh I, Berg K, Kman N. Thrombogenic Catheter-Associated Superior Vena Cava Syndrome. Case Rep Emerg Med. 2013;2013:793054.
7. Nascimbene A, Angelini P. Superior Vena Cava Thrombosis and Paradoxical Embolic Stroke due to Collateral Drainage from the Brachiocephalic Vein to the Left Atrium. Tex Heart Inst J. 2011;38(2):170-173.
8. Cohen R, Mena D, Carbajal-Mendoza R, Matos N, Karki N. Superior vena cava syndrome: A medical emergency? Int J Angiol. 2008;17(1):43-46.