ONCOLOGY

SUPERIOR VENA CAVA OBSTRUCTION

Introduction

5 min

Introduce yourself and the group

Provide rationale for the session and relevance to clinical practice

Outline learning objectives:

Demonstrate a structured approach to taking a focused history from a patient with suspected vena cava obstruction
Recognise key clinical signs of superior vena cava obstruction
Suggest key differential diagnoses of superior vena cava obstruction
Understand the initial management of superior vena cava obstruction

Explain structure of session

Total time:

45 min

Number of students:

1-5

Grade of students:

3rd to 5th year medical students

Created by:

Dr Harriet Mitchell

Uploaded:

21st September 2019

Last updated:

21st September 2019

Resources needed for this session:

Students can scan the QR code opposite to view all investigation results on their phone as you work through the session.

Resources linked to this session:

Activity 1: History Taking and Examination Skills

20 min

Ask the student(s) to take a focused history from a patient with superior vena cava obstruction. Ensure they explore past medical history (including treatment for any malignancy, if known), drug history, social history, family history and a full review of symptoms, particularly relevant if the patient does not have a known diagnosis of malignancy.

Ask the student(s) to perform a focused examination.

Activity 2: Case-Based Discussion and Diagnostic Reasoning

10 min

Ask the student(s) to present the key findings of history and examination.

Discuss the following points:

What differential diagnoses have been considered?
Discuss malignant and non-malignant causes of SVCO. Can students categorise each one into extra-luminal and intra-luminal causes?
What are the most common malignant causes?
What further investigations are useful to confirm the diagnosis?
What further investigations might be useful to determine the underlying cause?

Activity 3: Imaging

5 min

If possible, review the patient's imaging with the student. If none is available, use the example opposite. Students can scan the QR code to view on their phone if required. Ask the student(s) to identify key structures e.g.

right and left lung fields
vertebral column
aorta
superior vena cava

Ask them to demonstrate any obvious abnormalities. Identify the area of superior vena caval obstruction.

Activity 4: Management

5 min

Discuss the initial management of suspected superior vena cava obstruction.

Consider:

What pharmacological options are available? Are there any circumstances when these might be contraindicated?
What surgical/interventional options are available?
What specialties might need to be involved in the care of a patient with superior vena cava obstruction?
Where should they be managed?

Summary and Feedback

5 min

Questions

Identify and summarise key learning points (key three points if possible)

Feedback to student – highlight further learning needs

Feedback for teacher - ask students to provide feedback using the QR code opposite

References and Further Reading

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