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Case 169

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JJS, a 42-year-old male patient, developed 2 months ago a right-sided chest pain, with progressive worsening and radiating to right shoulder and neck associated with dry cough and dyspnoea. Evolved with cervicofacial oedema, exacerbated by the supine position. Refers weight loss of 7 kg over the past two months and episodes of chills and fever of 38°C. On clinical examination, there were cervicofacial and upper limbs oedema, more intense in left side. Presence of telangiectasia and collateral circulation in mammary, supraclavicular and infraclavicular regions.

Based on the clinical picture and the images, which one of the following is the most likely diagnosis?

a) Heart Failure

25%

b) Tumor of head and neck

25%

c) Superior vena cava syndrome

25%

d) Acute pericarditis

25%
   

Image analysis

 

Images 1 e 2: Photographies show facial, mandible, cervical and upper limbs oedema, slightly more intense in left side. Cervical region and upper portion of chest were plethoric. Telangiectasia and collateral circulation are seen in supraclavicular, infraclavicular and mammary regions. There is a node biopsy scar in the right supraclavicular region.

 

 

Image 3: Chest radiographies show mass in right hemithorax, and mediastinal widening with contralateral deviation of structures. 

 

Image 4: Contrast-enhanced chest Computerized Tomography (CT) scan.

Highlights

- Superior Vena Cava Syndrome is a set of congestive signs and symptoms resulting from blood flow obstruction through superior vena cava.

- Diagnosis is essentially clinical. Imaging tests such as CT and upper cavography is based on the identification of compromised venous drainage.

- Etiological diagnosis guides therapeutic approach.

References

- Lopez M, Laurentis J. Semiologia Médica. 5 ª ed.

- Cordeiro SZB, Cordeiro PB. Síndrome de veia cava superior. J Pneumol 2002;28(5):288-93.

- Porto CC, Porto AL. Semiologia Médica. 6ª ed

- Cervantes A, hirivella I. Oncological Emergencies. Ann Oncol. 2004; 15 Suppl 4:iv299-306.

Authors

Júlio Guerra Domingues, 6th year medical student at UFMG.

E-mail: jgdjulio[arroba]gmail.com

Lucas Diniz Machado, 6th year medical student at UFMG.

E-mail: lucasdiamantina[arroba]hotmail.com

Supervisors

Valéria Maria Augusto, Professor of the Department of Clinical Medicine at UFMG School of Medicine.

E-mail: vmaopneumo[at]gmail.com

José Nelson Mendes Vieira, Professor of the Department of Anatomy at UFMG School of Medicine. E-mail: zenelson.vieira[at]gmail.com

Reviewers

Letícia Horta, Júlia Petrocchi, Barbara Bragaglia, Luanna Monteiro and professor Viviane Parisotto.

Translated by

Ana Júlia Furbino Dias Bicalho, 6th year medical student at UFMG.

Email: anajuliabicalho[at]gmail.com

Acknowledgments 

This material was developed in partnership with Medical Semiology Teaching - Clinical Medicine department of UFMG School of Medicine.

Test question

a)

25%

b)

25%

c)

25%

d)

25%

e)

25%
   

Commentics

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