Case 84

Published on 13/02/2015 by admin

Filed under Cardiovascular

Last modified 22/04/2025

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CASE 84

History: A patient presents with facial swelling.

1. What are potential causes of this appearance? (Choose all that apply.)

A. Fibrosing mediastinitis

C. Angiosarcoma

2. Which vessel is most severely narrowed?

B. Superior vena cava

C. Descending aorta

D. Ascending aorta

3. What is the most likely diagnosis?

A. Fibrosing mediastinitis

C. Angiosarcoma

4. What is the most appropriate treatment in the acute setting?

A. Chemotherapy

B. Radiation therapy

ANSWERS

CASE 84

Superior Vena Cava Syndrome

2. B

3. D

4. B

References

Sheth S, Ebert MD, Fishman EK. Superior vena cava obstruction evaluation with MDCT. AJR Am J Roentgenol. 2010;194(4):W336–W346.

Wilson LD, Detterbeck FC, Yahalom J. Clinical practice Superior vena cava syndrome with malignant causes. N Engl J Med. 2007;356(18):1862–1869.

Comment

Clinical Presentation and Etiology

Signs and symptoms of superior vena cava syndrome are facial fullness and flushing, headache, upper extremity edema, and prominence of veins in the face and upper chest. The acute manifestation can be life-threatening. Most cases occur secondary to bronchogenic cancer. Other causes include fibrosing mediastinitis (most commonly secondary to histoplasmosis), lymphoma, other malignant tumors, and superior vena cava thrombosis.

Imaging

CT can be performed to assess the mediastinum and to demonstrate the narrowing of the superior vena cava (Figs. A and B). MRI also can be performed to evaluate venous stenosis or occlusion and to identify the cause of narrowing.

Related

Cardiac Imaging Case Review Series 2e