Scenario: You have been called to see a consult for a patient with mental status change and anasarca. On arrival you noticed a young man lying supine in bed with facial edema, upper extremity edema, lethargy, papilledema and neck veins visible. You suspect Superior Vena Caval Snydrome. What is the first thing you will do, may be even before start talking to patient ?
Answer: Have patient sit upright.
Patients with apparent clinical SVC syndrome gain significant symptomatic improvement from elevation of the head of the bed due to release of fluid pressure with gravity. It is a very benign maneuver but very significant for a patient as it provides dramatic relief of symptoms.
This week The New England Journal of Medicine has a nice writeup on Superior Vena Cava Syndrome with Malignant Causes - Volume 356:1862-1869, Number 18, May 3, 2007
