A 60-year-old former smoker male presented to the emergency department due to fatigue, weight loss of >10kg in the previous month, and increased cervical circumference. On physical examination, he had asymmetry of the neck, with right jugular vein engorgement and a supraclavicular petrous mass.
A CT scan of the neck and chest identified a lobulated mass of 5.1cm, suggestive of an adenopathy conglomerate (Fig 1), a reduction in the lumen of the superior vena cava (Fig 1) and filling defects of the left brachiocephalic, right subclavian veins and bilateral internal jugular veins (Fig 2 and 3) according to a Superior Vena Cava Syndrome (SVCS).
The biopsy of the paratracheal mass revealed a lymph node metastasis from a primary adenocarcinoma of the lung. At this stage of the disease, he was proposed for palliative radiotherapy.
Considered an oncological emergency, requiring immediate radiotherapy in most cases, the treatment of malignant SVCS focuses on relieving symptoms and treating the underlying disease, with other therapeutic alternatives in addition to radiotherapy. This case is intended to focus on its diagnosis and to illustrate an unusual presentation with a massive bilateral extension.
Key words: Superior Vena Cava Syndrome, Bilateral internal jugular vein thrombosis, Mediastinal mass