Superior vena cava syndrome is due to extrinsic compression or obstruction of the superior vena cava. Cancer especially lung cancer and malignant lymphomas are the most common underlying causes. In rare cases of benign etiology you can also find thrombosis. Typical symptoms are neck swelling and distended veins over the chest, but also very serious symptoms like respiratory failure, cerebral edema, or seizures can occur. Symptoms depend on the grade of caval obstruction and time for development of obstruction. CT scan is required for diagnosis. Before starting treatment it is advantageous to establish a histologically proven diagnosis. Treatment options include radiotherapy or chemotherapy depending on the underlying diagnosis. A new effective option in management of superior vena cava syndrome is endovascular stenting. A few hours after stent implantation symptomatic improvement can be seen. This procedure is recommended especially in emergency settings. Only in cases of emergency can irradiation be started without pathologically proven diagnosis.