Superior vena cava syndrome differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hardik Patel, M.D., Maria Fernanda Villarreal, M.D. [2]

Overview

Superior vena cava syndrome should be differentiated from other causes of dyspnea and jugular venous distention, such as, cardiac tamponade, chronic obstructive pulmonary disease, mediastinitis, pneumonia, acute respiratory distress syndrome, and syphilis.[1]

Differentiating Superior Vena Cava Syndrome from other Diseases

The table below summarizes the findings that differentiate superior vena cava syndrome from other conditions that also cause dyspnea and jugular venous distention:

Differential Diagnosis Similar Features Differentiating Features
Cardiac tamponade
  • Elevated jugular venous pressure, reduced diastolic filling of the right ventricle, and hypotension
  • In cardiac tamponade, differentiating features include: muffled heart sounds, pericardial rub, and electrocardiographic changes
Chronic obstructive pulmonary disease
  • Elevated jugular venous pulse (JVP), dyspnea, and tachypnea
  • In cardiac tamponade, differentiating features include: history of chronic bronchitis, coarse crackles with inspiration, and spirometry with FEV1/FVC < 70%
Mediastinitis
  • Elevated venous pressure, tachypnea and dyspnea
  • In mediastinitis, differentiating features include: fever, positive confirmation of organisms and elevated leukocytes
Pneumonia
  • Hypotension, tachypnea, cough, and chest pain
  • In pneumonia, differentiating features include: Bronchial breath sounds, leukocytosis with left shift, positive blood culture, and altered laboratory findings (procalitonin)
Acute respiratory distress syndrome
  • Low blood pressure, hypotension, and dyspnea
  • In cardiac acute respiratory distress syndrome, differentiating features include: acute onset, bilateral infiltrates on chest radiograph sparing costophrenic angles, and pulmonary wedge pressure < 18 mmHg
Syphilis
  • Enlarged lymph nodes, hypotension and dysphagia
  • In syphilis, differentiating features include: Positive treponemal tests, history of unprotected sex, and superficial mucosal patches

References

  1. Menon A, Gupta A (2015). "Superior vena cava syndrome". Indian J. Med. Res. 142 (3): 350. doi:10.4103/0971-5916.166606. PMC 4669875. PMID 26458355.

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