SVC syndrome due to malignancy

We discussed a case about a young man with no significant past medical history, who presented with acute-subacute diffuse facial and neck swelling with associated headaches + dizziness + dyspnea on exertion, found to have SVC syndrome due to malignancy.

Differential diagnosis for facial swelling
Consider a framework based on location

  • Orbital / periorbital: cavernous sinus thrombosis; orbital cellulitis; myxedema coma
  • Subcutaneous: cellulitis
  • Submandibular: Ludwig’s angina; salivary gland pathology
  • Oral: Angioedema; anaphylaxis; dental infection; parotid infection
  • Misc: Trauma; SVC syndrome; malignancy; thyroid disease

Etiologies of SVC syndrome

  • Malignancy (majority of cases): NSCLC, SCLC, lymphoma, thymoma, germ cell malignancy
  • Non-malignant: Thrombus (catheter-associated); infections; aortic aneurysms; thyroid diseases; fibrosing mediastinitis

Treatment

  • Guided by severity of symptoms
  • Goal: treat underlying cause (e.g. malignancy) + relieve symptoms
  • Glucocorticoids (for steroid responsive malignancies e.g. lymphoma), chemotherapy, radiation therapy, surgical resection
  • Thrombus tx: Intravascular stenting, thrombolysis

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