Abstract:

Superior vena cave (SVC) obstruction can be a substantial contributor to morbidity and mortality in cancer and non-cancer patients. It is currently known to be almost exclusively secondary to malignancy, most frequently lung cancer. A case of SVC syndrome presenting with worsening right-sided chest pain, shortness of breath, facial swelling, neck distension, and cough developing over a period of 12 days is reported. The approach to diagnosis included imaging studies and tissue diagnosis. CT scan of the chest revealed a large right pericardial mass, hilar infrahilar adenopathy, moderate increased right base posterior effusion, and compressive atelectasis. A mediastinal lymph node CT guided core biopsy subsequently revealed adult T-cell lymphoblastic lymphoma. Due to rapid symptom progression, the patient was started on hyper-CVAD regimen and tumor lysis prophylaxis. The etiology, diagnosis, and treatment modalities of the SVC syndrome are discussed further in detail. Given the wide range of symptom severity, identifying and treating severe SVC syndrome promptly can be critical to patient outcomes.

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