I've Got a Case of the Blues: A Curious Case of Superior Vena Cava Syndrome

Document Type

Conference Proceeding

Publication Date

5-2025

Publication Title

American Journal of Respiratory and Critical Care Medicine

Abstract

Superior vena cava syndrome (SVCS) is a clinical condition in which its signs and symptoms depend on the degree of occlusion of the vena cava. The most common clinical symptoms include dyspnea, face or neck swelling and sense of head “fullness”. Less commonly seen are cyanosis of the upper body, neurological changes, and hoarseness.66-year-old female with a history of stage 4 small cell lung cancer in remission presented for throat pain, headache, and dyspnea. Computer tomography (CT) scan of the neck soft tissue showed possible large retropharyngeal abscess. The patient developed cyanosis to her head in which the initial diagnosis was anchored to a possible allergic reaction to imaging contrast. The patient remained hemodynamically stable on room air during this, however, she would become increasingly cyanotic with exertion. The patient’s initial CTs were reviewed with radiology, in which no cause was identified to explain the cyanosis. Due to continued cyanosis, a magnetic resonance venography of the head and neck was obtained which did not show a dural venous sinus thrombosis. The patient mentioned that her Mediport was able to flush, however, unable to draw blood. Subsequently, a right upper extremity venous doppler was performed which showed normal venous flow. A echocardiogram was obtained due to concern for shunting which showed a possible ventricular septal defect versus a Gerbody defect. Finally, a CT cardiac triple rule out was performed, which showed thrombosis of the bilateral brachiocephalic and subclavian veins extending into complete occlusion of the mid superior vena cava with extensive mediastinal and chest wall collaterals. The patient subsequently received a thrombectomy with port removal and stent placement by interventional radiology. Patient was recommended outpatient repeat echocardiogram as the findings on her initial echocardiogram as well as her retropharyngeal swelling likely could be attributed to the extensive thrombosis. Once the patient was successfully treated, the patient’s initial CT of the neck was reviewed again with interventional radiology, in which a portion of the brachiocephalic clot was visible.

Volume

211

First Page

A2201

Comments

American Thoracic Society (ATS) International Conference, May 16-21, 2025, San Francisco, CA

Last Page

A2201

DOI

10.1164/ajrccm.2025.211.Abstracts.A2201

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