ABC: časopis urgentne medicine (Jan 2015)
Unrecognized superior vena cava syndrome: Case report
Abstract
INTRODUCTION: Superior vena cava syndrome (SVCS) is caused by a blood flow obstruction through the superior vena cava. It occurs mostly due to intrathoracic malignancy and is one of the oncological urgencies. Up to 10 % of all right sided intrathoracic malignancies are complicated by SVCS. The therapy of choice is urgent irradiation of the thorax. CASE REPORT: A 43 year old male repeatedly visits the first aid service due to attacks of dyspnea. He has no comorbidities. The symptoms first appeared after a stressful event (death of mother). He was referred to a neuropsychiatrist, who diagnoses a somatoform disorder, but refers him to an otorhynolaryngologist (ORL) because of right-sided neck pain and swelling. The ORL specialist requests an ultrasound of the neck which shows several mid and lower jugular lymph nodes, up to 20 mm in diameter. This lymphadenomegaly was read as reactive, due to a high number of cavities in teeth. The patient was prescribed an antibiotic, and suggested that he see a stomatologist. Further attacks of dyspnea continue, and were treated with anxiolytics, without results. 2 month after the initial symptoms the patient is referred to an internist because of facial edema and dyspnea after antibiotic use, which was initially seen as an allergic reaction. Still the attending internist sent out for an chest x ray, which showed a lung mass, and an ultrasound which shower metastatic deposits in the liver. The patient was urgently transported to the Institute of Oncology of Vojvodina, where a CT showed superior vena cava compression by a tumor. He received urgent mediastinal irradiation, after which the symptoms went away. Time from initial symptoms to the diagnosis was 2 months.
