ACR Appropriateness Criteria® Thoracic Venous Occlusions-Suspected Superior Vena Cava Syndrome

Superior vena cava (SVC) syndrome occurs in approximately 15,000 people in the United States each year. It most commonly occurs secondary to thoracic malignancies, mostly primary lung cancer and lymphoma. The cause is occlusion of the SVC or brachiocephalic veins. The following recommendations for initial imaging evaluation of acute or chronic SVC syndrome are presented. Contrast-enhanced chest CT scans, particularly CT angiography/venography, with or without simultaneous inclusion of the neck are recommended studies. MRI with contrast and MR venography/MRA chest with or without contrast are also recommended studies. The recommended CT and MR studies work well to diagnose and evaluate the cause and extent of superior vena cava or brachiocephalic vein occlusion. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.