Yamini Patel, MD, MS
The Wright Center for Graduate Medical Education
Scranton, Pennsylvania
Disclosure information not submitted.
Mohammad Asim Amjad, M.B.B.S
Internal Medicine Resident
The Wright Center for Graduate Medical Education
Scranton, Pennsylvania
Disclosure information not submitted.
Viren Raheja, MD
Resident Physician - Internal Medicine
The Wright Center for GME, United States
Disclosure information not submitted.
Navharsh Sekhon, MD
Resident Physician
The Wright Center for Graduate Medical Education
Scranton, Pennsylvania
Disclosure information not submitted.
Pius Ochieng, MD, FCCM
Associate Professor of Medicine, Pulmonary and Critical Care Physician
Geisinger Community Medical Center
Scranton, Pennsylvania, United States
Disclosure information not submitted.
Title: Double Trouble presentation of lung cancer: Superior Vena Cava Syndrome and Cardiac Tamponade
Case Report Body
Introduction: Superior vena cava syndrome and cardiac tamponade are medical emergencies that may share symptoms like dyspnea and distended neck veins. Concurrent SVC syndrome and cardiac tamponade is a rare initial presentation of lung malignancy and we present a unique case of such an occurrence.
Case Presentation: A 52-year-old male with significant tobacco use presented with right-sided facial swelling, trouble breathing, and syncopal episodes following coughing. Physical examination was significant for chest varicosities, tachycardia with normal blood pressure. Laboratory tests were unremarkable. Chest X-ray showed complete right lung opacification. CT chest revealed a 13x13x13 cm right upper lobe mass occluding the right mainstem bronchus with mass effect on the trachea, moderate right pleural effusion, large pericardial effusion, and SVC compression. Venous duplex showed bilateral internal jugular vein, subclavian vein, and right brachiocephalic vein thromboses. Echocardiogram showed cardiac tamponade physiology. The patient was managed by a multidisciplinary approach consisting of medical/radiological oncology, cardiology, cardiothoracic surgery, pulmonology, vascular surgery, and ENT. Pericardiocentesis was performed as syncope was presumed to be due to tamponade. It revealed malignant effusion consistent with small cell cancer with extensive stage. The patient was started on eliquis for systemic anticoagulation. Subsequently, he underwent radiation, chemotherapy, and continues to do well with a reduced tumor burden.
Discussion: This extremely complex patient presented with two oncologic emergencies, SVC syndrome and cardiac tamponade. Concurrent SVC with cardiac tamponade in lung cancer is rare and the prevalence is unknown. SVC treatment can include vascular stent and many cases of cardiac tamponade after stent placement have been reported. A few cases of lymphomas and non-small lung cancer with simultaneous presentation of these conditions have been reported, we present one with small cell lung cancer.