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Superior vena caval obstruction from thrombus

Case contributed by Chia Wei Oh
Diagnosis certain

Presentation

Neck pain with bilateral arm swelling

Patient Data

Age: 60
Gender: Male

This CT chest demonstrates extensive and occlusive thrombus in the superior vena cava. Superiorly it extends into the inferior aspect of right jugular vein and subclavian vein.

Associated significant mediastinal lymphadenopathy, pleural effusion and thickening of the left lung interstitial.

Case Discussion

This is a gentleman with a known history of metastatic esophageal cancer and has been on long term therapeutic clexane for bilateral pulmonary embolism in the last few months. In this presentation, the patient's symptoms were highly suspicious for SVC obstruction. His SVC thrombosis could be due to hypercoagulable state secondary to underlying malignancy or possibly a clotting disorder. 

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