Superior vena cava (SVC) thrombus is a rare but potentially life-threatening condition where a blood clot forms in the superior vena cava, the vein carrying blood from the head, neck, and upper extremities to the heart. The incidence of SVC thrombosis is higher in patients with certain underlying medical conditions, such as malignancy, heart failure, and chronic obstructive pulmonary disease. In this case study, a 36-year-old African American female with a history of essential hypertension, type 2 diabetes, end-stage renal disease, anemia of chronic disease, obstructive sleep apnea, obesity, and preeclampsia presented with sudden onset of confusion six days postpartum. The patient was admitted for further evaluation and treatment. Imaging tests showed an acute infarct in the left parietal lobe with no intracranial hemorrhage and an echo density/mass in the SVC consistent with a thrombus. Risk factors for SVC thrombus included pregnancy, a hypercoagulable state, and issues with catheter placement. The increasing use of intravascular devices such as indwelling catheters and pacemaker wires has been implicated in the rising incidence of SVC thrombus. Complete occlusion of the SVC is usually symptomatic and presents with a clinical picture similar to SVC syndrome. The importance of early detection and intervention was highlighted in this case, as the patient was initially asymptomatic after the onset of neurological symptoms. Treatment involved discontinuing heparin and starting the patient on Apixaban without a loading dose. This case study emphasizes the potential risk factors and complications associated with SVC thrombus and highlights the importance of early detection and intervention.

Thromboses of the superior and inferior vena cava, either isolated or associated with distal deep venous thrombosis, are uncommon, but confer potentially serious morbidity and mortality. Incidence is increasing, especially with the prominence of intravascular devices. The range of treatment options is also expanding to include medical management, surgery, and endovascular techniques which are now frequently considered first line therapy due to lower reintervention rates and decreased periprocedural morbidity. Currently, there are no official guidelines for screening or treatment. This article reviews the etiology, diagnosis, and management of caval thromboses, including equipment, procedural steps, outcomes, and complications, particularly with regard to endovascular techniques, such as catheter-directed thrombolysis, pharmacomechanical catheter-directed thrombolysis, angioplasty, and stenting.