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