A 70-year-old man presents to the clinic with swelling and redness of his face and neck for the past three days. He also reports headaches, blurred vision, and occasional episodes of confusion over the past week. His past medical history includes non-small cell lung cancer, chronic obstructive pulmonary disease (COPD), and hypertension. His current medications include an albuterol inhaler, lisinopril, and a multivitamin. He has a 50-pack-year smoking history and drinks alcohol socially. His vital signs are as follows: temperature 98.6°F (37°C), blood pressure 140/90 mmHg, heart rate 88 beats/minute, respirations 18/minute, and oxygen saturation 95% on room air. On physical examination, there is noticeable facial edema, distended neck veins, and erythema of the face and neck.
D) Superior vena cava syndrome
Superior vena cava syndrome results in edema and redness of the neck and face and central nervous system symptoms such as headache, visual symptoms, and altered mental status. It is due to compression of the superior vena cava resulting in impaired venous drainage from the head and neck. This patient's history of lung cancer and the described symptoms suggest superior vena cava syndrome.
Answer choice A: Carotid artery dissection, is incorrect. Carotid artery dissection typically presents with neck pain, headache, and sometimes Horner syndrome, but it does not cause facial and neck edema or distended neck veins.
Answer choice B: Cerebral venous sinus thrombosis, is incorrect. Cerebral venous sinus thrombosis can cause headache and visual symptoms but does not cause facial and neck edema or distended neck veins.
Answer choice C: Pulmonary embolism, is incorrect. Pulmonary embolism typically presents with sudden onset of dyspnea, chest pain, and sometimes hemoptysis, but it does not cause facial and neck edema or distended neck veins.
Answer choice E: Thoracic outlet syndrome, is incorrect. Thoracic outlet syndrome can cause upper extremity swelling and pain but does not typically cause facial and neck edema or central nervous system symptoms.
Key Learning Point
Superior vena cava syndrome results in edema and redness of the neck and face and central nervous system symptoms such as headache, visual symptoms, and altered mental status. It is due to compression of the superior vena cava resulting in impaired venous drainage from the head and neck.
