Superior vena cava (SVC) syndrome: facial/neck swelling, plethora, jugular distension, ve...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-ONCOLOGIC-EMERGENCY-SVC`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	None declared
Sources	`SRC-NCCN-BCELL-2025` `SRC-NCCN-NSCLC-2025`

Red Flag Origin

Definition	Superior vena cava (SVC) syndrome: facial/neck swelling, plethora, jugular distension, venous collateral, dyspnea/stridor due to obstructed superior vena cava blood flow by mediastinal mass. Triggers urgent steroids, expedited histologic diagnosis, immediate initiation of disease-directed therapy (chemotherapy for chemosensitive histologies, RT for chemorefractory), and consideration of endovascular SVC stenting for severe symptoms.
Clinical direction	intensify
Category	oncologic-emergency

Trigger Logic

{
  "any_of": [
    {
      "finding": "svc_syndrome",
      "value": true
    },
    {
      "finding": "svc_obstruction",
      "value": true
    }
  ],
  "type": "composite_score"
}

Notes

SVC syndrome causes: SCLC (~10% present with SVC), NSCLC, lymphoma (PMBCL, DLBCL with bulky mediastinal mass, T-LBL), thymic carcinoma, mediastinal germ cell tumors, indwelling catheter thrombosis. Treatment urgency depends on YR-Kishi grade — grade 3-4 (laryngeal/ cerebral edema, hemodynamic compromise) needs immediate stenting + empiric steroids while awaiting biopsy. Avoid empiric XRT before biopsy — destroys diagnostic tissue, common error in lymphoma presentations. Steroids dexamethasone 4-10 mg q6h initially. Once histology confirmed: PMBCL/DLBCL — DA-EPOCH-R or R-CHOP cycle 1 with TLS prophylaxis; SCLC — platinum-etoposide + atezolizumab; T-LBL — hyper-CVAD or pediatric-inspired. Stenting via IR provides relief in 24-72h regardless of histology.

Used By

No reverse references found in the YAML corpus.