Superior vena cava obstruction (grading)

Changed by Yuranga Weerakkody, 15 Sep 2016

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SVC obstruction can cause SVC syndrome which is the most common condition affecting this vessel. It can be secondary to an extrinsic compression or intraluminal thrombosis/stenosis. Collateral pathways, with the azygos vein being the most important collateral vessel, form in response to severe narrowing or obstruction to drain blood into the heart.

Five distinct grades of SVC obstruction has been introduced:

  • Gradegrade 0: SVC narrowing without clinical evidence of SVC syndrome
  • Gradegrade I:
    • Ia: mild SVC narrowing without collaterals
    • Ib: Moderate SVC narrowing without collaterals
  • Gradegrade II: severe SVC narrowing above the azygos with the azygos vein serving as partial collateral
  • Gradegrade III: SVC obstruction below the azygos arch
  • Gradegrade IV: SVC obstruction at the azygos arch
  • -<li>Grade 0: SVC narrowing without clinical evidence of SVC syndrome</li>
  • -<li>Grade I:<ul>
  • -<li>Ia: mild SVC narrowing without collaterals</li>
  • -<li>Ib: Moderate SVC narrowing without collaterals</li>
  • +<li>
  • +<strong>grade 0</strong>: SVC narrowing without clinical evidence of SVC syndrome</li>
  • +<li>
  • +<strong>grade I</strong>:<ul>
  • +<li>
  • +<strong>Ia</strong>: mild SVC narrowing without collaterals</li>
  • +<li>
  • +<strong>Ib</strong>: Moderate SVC narrowing without collaterals</li>
  • -<li>Grade II: severe SVC narrowing above the azygos with the azygos vein serving as partial collateral</li>
  • -<li>Grade III: SVC obstruction below the azygos arch</li>
  • -<li>Grade IV: SVC obstruction at the azygos arch</li>
  • +<li>
  • +<strong>grade II</strong>: severe SVC narrowing above the azygos with the azygos vein serving as partial collateral</li>
  • +<li>
  • +<strong>grade III</strong>: SVC obstruction below the azygos arch</li>
  • +<li>
  • +<strong>grade IV</strong>: SVC obstruction at the azygos arch</li>

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