Adolescent with facial swelling

BackgroundA previously well 15-year-old girl presented with a 2-month history of facial swelling that progressively worsened to involve the neck. There was associated dyspnoea, orthopnoea, headache and throat discomfort. Two weeks before presentation, the patient had an episode of fever for 5 days. On examination, vital signs were within normal limits. Swelling, plethora and venous distension of the face and neck were apparent (figure 1).Figure 1(A) Patient before the onset of symptoms. (B) Patient at presentation.QuestionsWhat is the most likely diagnosis?Superior vena cava syndromeAngioedemaAnasarcaDiphtheriaDescribe the chest X-ray (figure 2).What are the acute concerns?What investigations would you order?Figure 2Chest X-ray of the patient at presentation.Answers can be found on page 02.

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Woman in her 50s with shortness of breath on exertion

Heart ◽

10.1136/heartjnl-2018-313655 ◽

2018 ◽

Vol 105 (2) ◽

pp. 110-110

Author(s):

Takao Konishi ◽

Hironori Murakami ◽

Shinya Tanaka

Keyword(s):

Tricuspid Regurgitation ◽

Vena Cava ◽

List Type ◽

Shortness Of Breath ◽

Supplementary Data ◽

X Ray ◽

Doppler Image ◽

Chest X Ray ◽

Supplementary Material ◽

Axis View

Clinical introductionA 59-year-old woman visited an outpatient cardiology clinic due to shortness of breath on exertion. Physical examination showed no significant abnormality of vital signs. A III/VI systolic murmur was heard on the fourth intercostal space at the right sternal border. The majority of laboratory tests were normal. Chest X-ray showed a curved vessel shadow (figure 1A). Initial transthoracic echocardiography showed abnormal blood flow into the inferior vena cava (IVC) in the subxiphoid long axis view (figure 1B) and mild right heart dilatation (online supplementary figure 1). Transoesophageal echocardiography showed severe tricuspid regurgitation (online supplementary figure 2).Figure 1(A) Chest X-ray. (B) Colour Doppler image in the subxiphoid long axis view.Supplementary dataSupplementary dataQuestionWhat is the most likely underlying disease for the patient’s shortness of breath on exertion?Pulmonary arteriovenous fistula.Pulmonary arterial hypertension.Lung cancer.Partial anomalous pulmonary venous connection.Isolated tricuspid regurgitation.

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Superior vena cava syndrome presenting as persistent erythematous oedema of the face

Clinical and Experimental Dermatology ◽

10.1046/j.1365-2230.2000.00613.x ◽

2000 ◽

Vol 25 (3) ◽

pp. 198-200 ◽

Cited By ~ 11

Author(s):

T. Jansen ◽

R. Romiti ◽

G. Messer ◽

M. Stücker ◽

P. Altmeyer

Keyword(s):

Superior Vena Cava ◽

Superior Vena Cava Syndrome ◽

Superior Vena ◽

Vena Cava ◽

The Face ◽

Vena Cava Syndrome

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The intracavitary electrocardiography method for positioning the tip of epicutaneous cava catheter in neonates: Pilot study

The Journal of Vascular Access ◽

10.1177/1129729818761292 ◽

2018 ◽

Vol 19 (6) ◽

pp. 542-547 ◽

Cited By ~ 5

Author(s):

Antonella Capasso ◽

Rossella Mastroianni ◽

Annalisa Passariello ◽

Marta Palma ◽

Francesco Messina ◽

...

Keyword(s):

Pilot Study ◽

Superior Vena ◽

False Negative ◽

Vena Cava ◽

P Wave ◽

Target Zone ◽

X Ray ◽

Catheter Tip ◽

Chest X Ray ◽

Head Neck

Purpose: The neonatologists of Sant’Anna and San Sebastiano Hospital of Caserta have carried out a pilot study investigating the safety, feasibility, and accuracy of intracavitary electrocardiography for neonatal epicutaneous cava catheter tip positioning. Patients and methods: We enrolled 39 neonates (1–28 days of postnatal age or correct age lower than 41 weeks) requiring epicutaneous cava catheter in the district of superior vena cava (head–neck or upper limbs). Intracavitary electrocardiography was applicable in 38 neonates. Results: No significant complications related to intracavitary electrocardiography occurred in the studied neonates. The increase in P wave on intracavitary electrocardiography was detected in 30 cases. Of the remaining eight cases, six malpositioned catheters tipped out of cavoatrial junction–target zone (chest x-ray and echocardiographical control) and two were false negative (tip located in target zone). The match between intracavitary electrocardiography and x-ray was observed in 29/38 cases, and the same ratio between intracavitary electrocardiography and echocardiography was detected. Conclusion: We conclude that the intracavitary electrocardiography method is safe and accurate in neonates as demonstrated in pediatric and adult patients. The applicability of the method is 97% and its feasibility is 79%. The overall accuracy is 76% but it rises to 97% if “peak” P wave is detected.

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From suspicion of angioedema to the diagnosis of lung cancer

Oncoreview ◽

10.24292/01.or.320251020 ◽

2020 ◽

Vol 10 (3) ◽

pp. 108-112

Author(s):

Łukasz Moos ◽

Wojciech Żurek ◽

Katarzyna Kapeluszna ◽

Zenon Brzoza

Keyword(s):

Lung Cancer ◽

Differential Diagnosis ◽

Superior Vena Cava Syndrome ◽

Superior Vena ◽

Vena Cava ◽

Small Cell ◽

Case Presentation ◽

Facial Swelling ◽

Vena Cava Syndrome ◽

Diagnosis Of Lung Cancer

Angioedema is a localized and self-limiting oedema of the subcutaneous and submucosal tissue. Case presentation: 73-year-old man was admitted to the Division of Allergology with the diagnosis of angioedema. Detailed physical examination led to the suspicion of superior vena cava syndrome with secondary face swelling. Biopsy revealed metastasis of small cell carcinoma in superclavicular lymph nodes. Conclusions: Facial swelling, especially recurrent and non-inflammatory, is often, but not always caused by angioedema. Insightful differential diagnosis is crucial before making the final one.

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Goiter in a Patient with Pulmonary Arterial Hypertension Treated with Epoprostenol

Case Reports in Pulmonology ◽

10.1155/2020/1617253 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Shaadi Abughazaleh ◽

Zeenat Safdar

Keyword(s):

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Thyroid Disease ◽

Superior Vena ◽

Vena Cava ◽

Large Goiter ◽

Facial Swelling ◽

Vena Cava Syndrome ◽

Pulmonary Arterial

A 35-year-old female with pulmonary arterial hypertension (PAH) who presented with complaints of progressively worsening dysphagia, facial swelling, and shortness of breath, was found to have a large goiter. In patients treated with epoprostenol for long periods of time, thyroid disease is common. Most cases of thyroid disease describe thyrotoxicosis and hyperthyroid statues, but our case was a patient on long term IV epoprostenol presenting with a superior vena cava-syndrome (SVC) like appearance and airway compromise found to have a goiter incidentally during workup.

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Malignant superior vena cava syndrome presenting after trauma

CJEM ◽

10.1017/s148180350000381x ◽

1999 ◽

Vol 1 (02) ◽

pp. 112-114

Author(s):

Laura A. Price ◽

Trevor L. Gilkinson

Keyword(s):

Superior Vena Cava ◽

Malignant Disease ◽

Motor Vehicle ◽

Superior Vena Cava Syndrome ◽

Superior Vena ◽

Vena Cava ◽

Motor Vehicle Crash ◽

Svc Syndrome ◽

Facial Swelling ◽

Vena Cava Syndrome

SUMMARY: A 41-year-old man was brought to the ED after a motor vehicle crash. On presentation, he demonstrated symptoms compatible with superior vena cava (SVC) syndrome, including extreme dyspnea, face and neck cyanosis and facial swelling. A chest tube was inserted and drained large amounts of sanguineous fluid. An exploratory thoracotomy revealed an extensive tumour encasing the SVC and the hilum. Biopsy confirmed the diagnosis of T-cell lymphoma. The most common cause of SVC syndrome is malignant disease, with bronchogenic carcinoma and lymphoma being most frequent. Review of the literature uncovered only a few anecdotal reports of traumatic SVC syndrome. There are no previous reported cases of malignant SVC syndrome presenting in association with trauma.

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Persistent Left Superior Vena Cava: Chest X-Ray and Echocardiographic Findings

Echocardiography ◽

10.1111/j.1540-8175.2000.tb01164.x ◽

2000 ◽

Vol 17 (5) ◽

pp. 453-455 ◽

Cited By ~ 18

Author(s):

Marie Dearstine ◽

Wayne Taylor ◽

Edmund K. Kerut

Keyword(s):

Superior Vena Cava ◽

Superior Vena ◽

Vena Cava ◽

Left Superior Vena Cava ◽

Persistent Left Superior Vena ◽

X Ray ◽

Chest X Ray ◽

Echocardiographic Findings

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Facial Swelling Due To Superior Vena Cava Syndrome

10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a6183 ◽

2012 ◽

Author(s):

M Chadi Alraies ◽

Khaldoon Shaheen ◽

Abdul Hamid Alraiyes

Keyword(s):

Superior Vena Cava ◽

Superior Vena Cava Syndrome ◽

Superior Vena ◽

Vena Cava ◽

Facial Swelling ◽

Vena Cava Syndrome

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Unusual malposition of a peripherally inserted central catheter into the left pericardiophrenic vein: A case report

The Journal of Vascular Access ◽

10.1177/11297298211018945 ◽

2021 ◽

pp. 112972982110189

Author(s):

Alfonso Piano ◽

Annamaria Carnicelli ◽

Emanuele Gilardi ◽

Nicola Bonadia ◽

Kidane Wolde Sellasie ◽

...

Keyword(s):

Atrial Fibrillation ◽

Superior Vena ◽

Vena Cava ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

X Ray ◽

Bubble Test ◽

Chest X Ray ◽

The Right ◽

Pericardiophrenic Vein

We report a case of primary malposition of a PICC inserted by guidewire replacement in the emergency room. Intraprocedural tip location by intracavitary electrocardiography was not feasible because the patient had atrial fibrillation; intraprocedural tip location by ultrasound (using the so-called “bubble test”) showed that the tip was not in the superior vena cava or in the right atrium. A post-procedural chest X-ray confirmed the malposition but could not precise the location of the tip. A CT scan (scheduled for other purposes) finally visualized the tip in a very unusual location, the left pericardiophrenic vein.

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Ultrasonography Versus Chest X-Ray to Confirm Proper Placement of Central Venous Catheter

Iranian Journal of Radiology ◽

10.5812/iranjradiol.100437 ◽

2020 ◽

Vol 17 (3) ◽

Author(s):

Mehrnaz Nikouyeh ◽

Kiandokht Khorshidi ◽

Mohammad Hassan Rouzegari ◽

Rabee Sarram

Keyword(s):

Central Venous Catheter ◽

Superior Vena ◽

Vena Cava ◽

Venous Catheter ◽

Underlying Disease ◽

Central Venous ◽

X Ray ◽

Comparison Results ◽

Chest X Ray ◽

The Right

Background: Central venous catheter (CVC) is located within the proximal third of the superior vena cava, inferior vena cava, or the right atrium. The confirmation of right location of catheter’s tip is done by chest X-ray (CXR) routinely. Objectives: In this study, we compared the proper location of the tip of the catheter by ultrasonography with CXR. Patients and Methods: One hundred and seventeen patients were included in this study. The CVC was placed according to the underlying disease. The proper location of the catheter was checked by ultrasonography and then CXR was carried out. The results of both methods were recorded and finally the statistical analysis was performed for comparison. Results: The tip of the catheter was observed by ultrasonography in 111 patients, but in the six other ones, the tip of the catheter was not observed by ultrasonography and observed in CXR. Therefore, the sensitivity of ultrasonography was 94.9 % in this study. Conclusion: The results showed that ultrasonography shows the catheter in 94.9% of the cases, although the risk of exposure to X-ray does not exist. The cost and time for evaluation of the tip of the catheter is significantly less by using ultrasonography compared to CXR.

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