Workup/Staging

Question 1

Describe the workup of SVC syndrome.

Answer 1

SVC syndrome workup: H&P, assessment of respiratory status, CXR and/or CT chest with contrast (best to visualize the extent of blockage), determination of the best Bx route if Dx is unknown, labs (AFP, LDH, β-HCG), and BM aspirate and Bx

Question 2

Name 5 ways to obtain tissue Dx for SVC syndrome.

Answer 2

Methods to obtain tissue Dx in SVC syndrome:

Sputum cytology
Bx of palpable LNs
Bronchoscopy
Mediastinoscopy
Video-assisted thoracoscopic Sg

Question 3

What is usually seen on CXR in SVC syndrome?

Answer 3

CXR findings in SVC syndrome include a widened mediastinum and the presence of a mass near the SVC.

Question 4

What CT finding is closely associated with SVC syndrome?

Answer 4

The presence of collateral vessels is a CT finding that closely relates to SVC syndrome.

Question 5

Why should RT not be given prior to a histologic Dx in SVC syndrome?

Answer 5

RT may obscure the histologic Dx and should be deferred until diagnostic Bx is obtained in SVC syndrome. However, empiric Tx may be considered in the setting of airway obstruction or cerebral edema.