Superior vena cava syndrome with extensive collateral vessels

摘要

An 84‐year‐old man visited a lung cancer clinic with a history of facial swelling of one week's duration. The patient was a 45 pack per year former smoker who had previously quit smoking 19 years ago. On examination, extensively dilated superficial vessels were noted on his torso (Fig a,b). Chest computed tomogram subsequently revealed almost complete occlusion of the superior vena cava by a huge mass in the right upper lung, together with enlarged mediastinal lymph nodes (Fig c). Chemotherapy with etoposide and cisplatin was administered following cervical lymph node biopsy and the diagnosis of small‐cell carcinoma. Nine days after the first dose of chemotherapy, the patient visited the emergency department and was diagnosed with febrile neutropenia. Figure d was taken on the 11th day after the first dose of chemotherapy and showed markedly decreased collateral vessels on his chest. This case demonstrates that complete relief of symptoms of vena caval obstruction can be achieved with chemotherapy in approximately 80% of patients with small‐cell lung cancer.