FROM AN ALLERGIC REACTION TO A SUPERIOR VENA CAVA SYNDROME

  • Vojislava Milutinović KBC Bežanijska kosa, Ulica Dr Žorža Matea, 11070 Beograd
Keywords: superior vena cava syndrome, allergy, urgent radiotherapy

Abstract


Abstract

Introduction: Superior vena cava syndrome ( SVCS) is a collection of clinical signs and symptoms resulting from partial or complete obstruction of blood flow through the SVC.  

Case report: An eighty-year-old patient with an allergy diagnosis was referred from the Community Health Centre to the Internal Medicine Clinic. The patient had previously been treated with antihistamines for days due to swelling and facial redness, which showed no signs of improvement. During the chest x-ray, a widened shadow of the upper side of the mediastinum on the right side was noticed.  A CT chest scan showed an infiltrative change and a significantly compressed upper vena cava due to the mediastinal adenopathy.

Conclusion: If primarily manifested by skin symptoms, the diagnosis of superior vena cava syndrome can be easily overlooked. In the presented case, this rare syndrome was the first symptom  of intrathoracic malignancy.

References

1. Seligson MT, Surowiec SM. Superior Vena Cava Syndrome. 2022 Sep 26. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 28723010.
2. Dragomir L, Marina V, Anghele M, Anghele A-D. Clinical or Imaging Diagnosis of the Current Medical Practice for Superior Vena Cava Syndrome? Diagnostics. 2021; 11(11):2058. https://doi.org/10.3390/diagnostics11112058
3. Nickloes T, Long C, Mack L, Kallab A. Superior Vena Cava Syndrome [Internet].
Emedicine.medscape.com. 2022 [cited 08. March 2022].
4. Patriarcheas V, Grammoustianou M, Ptohis N, Thanou I, Kostis M, Gkiozos I et al. Malignant Superior Vena Cava Syndrome: State of the Art. Cureus. 2022 Jan 4;14(1):e20924. doi: 10.7759/cureus.20924. PMID: 35004083; PMCID: PMC8727327
5. Sun M, Chen X, Li H, Zhang X, Wang X, Zheng R, et al. Clinical analysis of 48 cases of malignant superior vena cava syndrome. World J Surg Oncol. 2021 Jun 23;19(1):185. doi: 10.1186/s12957-021-02300-8. PMID: 34162380; PMCID: PMC8223363.
6. Superior Vena Cava Syndrome in Emergency Medicine, Michael S Beeson Emedicine.medscape.com.2022[cited 28. Sep 2022].
7. Azizi AH, Shafi I, Shah N, Rosenfield K, Schainfeld R, Sista A,et al. Superior Vena Cava Syndrome. JACC Cardiovasc Interv. 2020 Dec 28;13(24):2896-2910. doi: 10.1016/j.jcin.2020.08.038. PMID: 33357528.
8. Quencer KB. Superior Vena Cava Syndrome: Etiologies, Manifestations, and Treatments. Semin Intervent Radiol. 2022 Aug 31;39(3):292-303. doi: 10.1055/s-0042-1753480. PMID: 36062219; PMCID: PMC9433155.
9. Lepper PM, Ott SR, Hoppe H, Schumann C, Stammberger U, Bugalho A, et al. Superior vena cava syndrome in thoracic malignancies. Respir Care. 2011 May;56(5):653-66. doi: 10.4187/respcare.00947. Epub 2011 Jan 27. PMID: 21276318.
10. Tonkin R, Sladden C. What lies downstream? A case of superior vena cava syndrome presenting in the dermatology clinic: A case report. SAGE Open Med Case Rep. 2020 May 20;8:2050313X20919618. doi: 10.1177/2050313X20919618. PMID: 32547755; PMCID: PMC7249544.
11. Johnson JS, Kotora JG, Bechtel BF. Superior vena cava syndrome masquerading as an allergic reaction. Am J Emerg Med. 2012 Nov;30(9):2100.e1-3. doi: 10.1016/j.ajem.2012.02.006. Epub 2012 Mar 29. PMID: 22463972.
12. Yong AS, Haque Hussain SS, Marrouche N, Grattan CE. Superior vena cava obstruction presenting as acute allergy. Clin Exp Dermatol. 2013 Dec;38(8):955-6. doi: 10.1111/ced.12134. Epub 2013 Apr 20. PMID: 23600471
13. Pope C, Pillai SK. Intermittent facial swelling. BMJ Case Rep. 2014 Oct 17;2014:bcr2013202355. doi: 10.1136/bcr-2013-202355. PMID: 25326556; PMCID: PMC4202060
Published
2024/04/03
Section
Case report