Symptoms

  • Usually occurs with mediastinal tumours
  • Shortness of breath and cough
  • Difficulty swallowing
  • Headache
  • Feeling of ‘fullness’ in head and swelling of the face
  • Stridor.

 

Signs

  • Usually a gradual onset of symptoms
  • Oedema of face and arms
  • Dusky colour of skin and distended superficial veins in face neck and thorax
  • Breathlessness (worse lying flat)
  • Pemberton’s sign (the face becomes more cyanosed on raising the arms)
  • Can be associated with significant oedema of the epiglottis.

 

Management

  • Admission to hospital
  • In patients without a known cancer diagnosis an urgent diagnostic pathway should be initiated as corticosteroids should not usually be commenced until tissue samples have been taken
  • In patients with a known cancer diagnosis consider a trial of corticosteroids, with gastroprotection (usually proton pump inhibitor),
  • †Dexamethasone 8mg to 16mg orally (or IV) immediately and subsequently †Dexamethasone 4mg to 8mg twice daily orally (second dose before 2pm if possible). Discontinue promptly if no benefit and reduce gradually in responders.
  • Referral to oncology is important to establish whether disease‑modifying treatment or palliative radiotherapy can be offered
  • Stenting via interventional radiology can be helpful and usually results in rapid improvement of symptoms
  • Fans and oxygen can make the patient feel more comfortable.