Curr Emerg Med

Current Emergency Medicine, ISSN NoIssnPrint print, 0000-0000 online, Open Access

Article copyright, the authors; Journal compilation copyright, Curr Emerg Med and Elmer Press Inc

Journal website https://cem.elmerpub.com

Original Article

Volume 1, July 2026, e3

Clinical Presentation of Vena Cava Syndrome in the Oncologic Intensive Care Unit: A Case Series

↓ Figure 1. Distribution plots of age, tumor lesion volume, LVEF, and TAPSE. LVEF and TAPSE are shown together with their respective violin and box plots, illustrating the descriptive distribution of each variable. LVEF: left ventricular ejection fraction; TAPSE: tricuspid annular plane systolic excursion.

↓ **Table 1.** Clinical Characteristics, Severity, Complications, and Outcomes (N = 19)
Characteristic	Value
Percentages are reported over the full cohort (n = 19) unless otherwise specified. Denominators are shown for thrombosis- and ventilatory failure-specific subgroups. AKI: acute kidney injury; KDIGO: Kidney Disease: Improving Global Outcomes; ECOG: Eastern Cooperative Oncology Group; IQR: interquartile range; LVEF: left ventricular ejection fraction; SD: standard deviation; SVC: superior vena cava; TAPSE: tricuspid annular plane systolic excursion.
Demographic and oncologic characteristics
Age, years	46.5 ± 20.1
Male sex	11 (57.9%)
Solid tumors	11 (57.9%)
Hematologic malignancies	8 (42.1%)
Most frequent diagnosis: non-Hodgkin lymphoma	7 (36.8%)
Lung carcinoma	3 (15.8%)
Other oncologic diagnoses	9 (47.4%)
Clinical presentation
Superior vena cava syndrome	14 (73.7%)
Inferior vena cava syndrome	5 (26.3%)
Tumor lysis syndrome	7 (36.8%)
Malignant hypercalcemia	1 (5.3%)
Respiratory presentation	17 (89.5%)
Neurologic presentation	2 (10.5%)
Main symptom: dyspnea	14 (73.7%)
Collateral circulation and imaging
Azygos/hemiazygos collateral pathway	11 (57.9%)
Internal thoracic collateral pathway	4 (21.1%)
Vertebral/paravertebral collateral pathway	3 (15.8%)
Lateral thoracic collateral pathway	1 (5.3%)
Cervical lymph node conglomerate	7 (36.8%)
Cervical mass	6 (31.6%)
Other tomographic findings	6 (31.6%)
Lesion volume, mm³	95.3 ± 42.6
Severity assessment
Yu grade 0	2 (10.5%)
Yu grade 2	3 (15.8%)
Yu grade 3	2 (10.5%)
Yu grade 4	12 (63.2%)
Kishi score > 4	13 (68.4%)
Thrombotic events and treatment
Any thrombotic event	9 (47.4%)
SVC thrombosis	4 (21.1%)
Jugular thrombosis	3 (15.8%)
Other thrombotic sites	2 (10.5%)
Anticoagulation among patients with thrombosis	7/9 (77.8%)
Dalteparin among patients with thrombosis	4/9 (44.4%)
Heparin among patients with thrombosis	3/9 (33.3%)
Vena cava filter among patients with thrombosis	2/9 (22.2%)
Critical care variables and outcomes
LVEF, median (IQR), %	58 (55–61)
TAPSE, mean ± SD, mm	23.6 ± 2.5
Ventilatory failure	15 (78.9%)
Type I ventilatory failure	5/15 (33.3%)
Type II ventilatory failure	2/15 (13.3%)
Type III ventilatory failure	2/15 (13.3%)
Type IV ventilatory failure	6/15 (40.0%)
Acute kidney injury	7 (36.8%)
KDIGO stage 3 among AKI cases	6/7 (85.7%)
ECOG 4	7 (36.8%)
In-hospital mortality	11 (57.9%)

↓ Table 1. Clinical Characteristics, Severity, Complications, and Outcomes (N = 19)

Characteristic

Value

Percentages are reported over the full cohort (n = 19) unless otherwise specified. Denominators are shown for thrombosis- and ventilatory failure-specific subgroups. AKI: acute kidney injury; KDIGO: Kidney Disease: Improving Global Outcomes; ECOG: Eastern Cooperative Oncology Group; IQR: interquartile range; LVEF: left ventricular ejection fraction; SD: standard deviation; SVC: superior vena cava; TAPSE: tricuspid annular plane systolic excursion.

Demographic and oncologic characteristics

Age, years

46.5 ± 20.1

Male sex

11 (57.9%)

Solid tumors

11 (57.9%)

Hematologic malignancies

8 (42.1%)

Most frequent diagnosis: non-Hodgkin lymphoma

7 (36.8%)

Lung carcinoma

3 (15.8%)

Other oncologic diagnoses

9 (47.4%)

Clinical presentation

Superior vena cava syndrome

14 (73.7%)

Inferior vena cava syndrome

5 (26.3%)

Tumor lysis syndrome

7 (36.8%)

Malignant hypercalcemia

1 (5.3%)

Respiratory presentation

17 (89.5%)

Neurologic presentation

2 (10.5%)

Main symptom: dyspnea

14 (73.7%)

Collateral circulation and imaging

Azygos/hemiazygos collateral pathway

11 (57.9%)

Internal thoracic collateral pathway

4 (21.1%)

Vertebral/paravertebral collateral pathway

3 (15.8%)

Lateral thoracic collateral pathway

1 (5.3%)

Cervical lymph node conglomerate

7 (36.8%)

Cervical mass

6 (31.6%)

Other tomographic findings

6 (31.6%)

Lesion volume, mm³

95.3 ± 42.6

Severity assessment

Yu grade 0

2 (10.5%)

Yu grade 2

3 (15.8%)

Yu grade 3

2 (10.5%)

Yu grade 4

12 (63.2%)

Kishi score > 4

13 (68.4%)

Thrombotic events and treatment

Any thrombotic event

9 (47.4%)

SVC thrombosis

4 (21.1%)

Jugular thrombosis

3 (15.8%)

Other thrombotic sites

2 (10.5%)

Anticoagulation among patients with thrombosis

7/9 (77.8%)

Dalteparin among patients with thrombosis

4/9 (44.4%)

Heparin among patients with thrombosis

3/9 (33.3%)

Vena cava filter among patients with thrombosis

2/9 (22.2%)

Critical care variables and outcomes

LVEF, median (IQR), %

58 (55–61)

TAPSE, mean ± SD, mm

23.6 ± 2.5

Ventilatory failure

15 (78.9%)

Type I ventilatory failure

5/15 (33.3%)

Type II ventilatory failure

2/15 (13.3%)

Type III ventilatory failure

2/15 (13.3%)

Type IV ventilatory failure

6/15 (40.0%)

Acute kidney injury

7 (36.8%)

KDIGO stage 3 among AKI cases

6/7 (85.7%)

ECOG 4

7 (36.8%)

In-hospital mortality

11 (57.9%)