Vena cava superior (VCS) is the largest vein in the body that collects returned blood from the head, upper extremities and upper chest to the heart. Superior vena cava syndrome (SVCS) occurs when obstruction of VCS restrain blood flow from the head, upper extremities and chest to the right atrium. The syndrome was first described by Wiliam Hunter in 1757 [1] and this case was due to syphilitic aortic aneurysm compression of VCS. Today malign diseases are responsible for syndrome in over 97% of cases, mostly due to extrinsic tumor compression following with compression by enlarged mediastinal lymph nodes [2]. However direct tumor vein invasion and intraluminal thrombosis can occurs. Lung cancer (small cell and non-small lung cell carcinoma) accounts for the majority of cases (75%) primary located on the right side which is four times frequent as those on the left because of vena cava superior anatomy [3]. Approximately 5 -10% of patients with lung malignancy will develop SVCS [4]. Other malignancy in thorax such a lymphoma accounting about 15% and metastasis (especially breast carcinoma about 7%) as well as other rarely mediastinal malignancy can be followed with SVCS also [5]. Benign conditions like, granulomatous mediastinal diseases, mediastinal fibrosis, struma, trauma, infections, aortitis, central venous lines, pacemaker which can cause SVCS which is beyond scope of this article. SVCS is usually diagnosed by clinical presentations with congestion and edema of the head and upper chest as well as vein distension across chest and neck. Dyspnoea is present in 50-80% of patients [6]. Pain, cough and hoarseness are reported relatively often also [6,7]. In severe cases of SVCS laryngeal and cerebral edema can occur following changing in mental status, syncopal attacks, lethargy, headache, stridor and coma [8]. Untreated tracheal obstruction/compression as well as brain herniation will result in death. The locations and time to onset of clinical manifest SVCS is in relation how severe symptoms are present. Collateral vessels that are usually described in SVCS are azygos and hemiazygos vein, intercostals, mediastinal, paravertebral, internal mammary, thoracico-epigastric, thoraco-acromioclavicular and anterior chest wall vein [9]. Usually it takes several weeks time to fully developing of collateral pathways. Vena azygos is very important vessel and symptoms are aggravated if the vena cava superior is compressed or occluded below origin of vein.