Examkin

Question

Difficulty: EasyHematology and Oncology

A 64-year-old man comes to the emergency department reporting progressive facial swelling and shortness of breath over the past two weeks. He notes that the swelling is worse in the morning when he wakes up and improves slightly throughout the day. The patient has a 40-pack-year smoking history and has not seen a physician in ten years. Vital signs are temperature 37.1°C (98.8°F), blood pressure 135/85 mmHg, pulse 98/min, and respirations 18/min. Physical examination reveals plethora and edema of the face and neck. Prominent, distended superficial veins are visible across the anterior chest wall. Auscultation of the lungs reveals decreased breath sounds over the right upper lung field. Which of the following is the most likely cause of this patient's presentation?

  1. Obstruction of blood flow through the superior vena cavaAnswer
  2. B
    Acute exacerbation of chronic obstructive pulmonary disease
  3. C
    Volume overload from acute decompensated heart failure
  4. D
    Mucopolysaccharide deposition due to severe hypothyroidism
  5. E
    Mast cell degranulation causing acute angioedema

Answer

Obstruction of blood flow through the superior vena cava
The correct answer accurately identifies the pathophysiology of Superior Vena Cava (SVC) syndrome. This patient's presentation—progressive facial and neck edema, plethora, and distended collateral veins on the anterior chest—is the classic hallmark of SVC obstruction. Given his heavy smoking history and decreased breath sounds in the right upper lung, the most likely etiology is a right-sided bronchogenic carcinoma compressing the SVC. The swelling is often worse in the morning due to lying supine overnight, which further compromises venous return.

Step-by-Step Solution

1
Analyze the patient's demographics and risk factors.
The patient is a 64-year-old man with a 40-pack-year smoking history.
Identifies the patient as being at exceptionally high risk for lung malignancies.
2
Evaluate the key physical examination findings.
The exam shows facial plethora, neck edema, and distended superficial chest veins, alongside right-sided decreased breath sounds.
These specific signs point directly to impaired venous return from the head and upper torso.
3
Synthesize findings to determine the most likely mechanism.
The combination of symptoms strongly suggests an external compression of the superior vena cava, an oncologic emergency known as SVC syndrome.
A right lung tumor is likely compressing the SVC, leading to venous backflow and engorgement of collateral veins.

Key Concept

Superior vena cava (SVC) syndrome is an oncologic emergency presenting with facial and neck swelling, plethora, and distended chest veins, most commonly caused by bronchogenic carcinoma compressing the SVC.
Rate this question

Topics

Hematology and Oncology

More questions from this topic