Oncological Crisis: Managing Superior Vena Cava Syndrome in the Emergency Department

Abstract

Superior vena cava syndrome (SVCS) results from obstruction of the superior vena cava (SVC) and is commonly associated with malignancies. However, its presentation can vary, and in rare cases, it may present as an oncological emergency with atypical symptoms. A 54-year-old male presented to the Emergency Department (ED) with syncope, breathlessness, and fever. Clinical examination revealed elevated jugular venous pressure, hypoxia, and engorged veins. Imaging identified superior vena cava obstruction due to a compressing mediastinal mass, alongside lung hyperinflation and emphysema. The patient’s history included Chronic Obstructive Pulmonary Disease (COPD) and extensive smoking. In the ED, he was managed with oxygen therapy, corticosteroids, and nebulization. A biopsy confirmed malignancy, and the patient was subsequently treated with chemotherapy. This case highlights the rare presentation of malignant SVCS as syncope and emphasizes the importance of including SVCS in the differential diagnosis for patients with a history of malignancy presenting with breathlessness and engorged veins. Effective management in the ED requires a multidisciplinary approach to address the complexities of oncological emergencies and improve patient outcomes. Keywords: Superior vena cava syndrome, Mediastinal mass, Chronic obstructive pulmonary disease, Emergency department, R-CHOP Regimen