Abstract
IntroductionSuperior Vena Cava Syndrome is a rare but potentially life-threatening condition that can occur during pregnancy. The case presented here describes a dramatic presentation culminating in a potentially preventable maternal death at a tertiary hospital in East Africa.Case presentationA HIV positive, 28 years old primegravida at a gestational age of 34 weeks presented to a tertiary health facility in Nothern Tanzania with generalised facial swelling and difficult in breathing .She was referred from primary health facility where she was treated presumptively as a case of Ludwings angina. On examination she was dyspnoeic and had extensive supraclavicular and cervical lymphadenopathy. On second day post-admission, she was induced ,but later her condition deteriorated and developed severe dyspnoeic, confusion, convulsions and died. A Narrative of this case, challenges encountered in investigating, establish a diagnosis and management are explored in this case report. Furthermore pathophysiology and treatment options for superior venal caval occurring in pregnancy will be reviewed.ConclusionSuperior vena syndrome is a fatal condition and rare to occur in pregnancy. A rigorous and timely approach to investigate and manage is of a critical importance. Additionally a collaborative multidisciplinary team approach is necessary to prevent complication.
Highlights
Superior Vena Cava Syndrome is a rare but potentially life-threatening condition that can occur during pregnancy
Superior Vena Cava Syndrome is often dramatic in its presentation and rarely seen in pregnancy
It was first described in the mid 1700s in a patient with a syphilitic aortic aneurysm, early reports showed most of the cases were related to an infectious process, most commonly syphilis or tuberculosis
Summary
Superior Vena Cava Syndrome is often dramatic in its presentation and rarely seen in pregnancy. Superior vena cava syndrome occurs in about 15,000 people in the United States each year; the incidence in Sub-Saharan Africa is unknown It was first described in the mid 1700s in a patient with a syphilitic aortic aneurysm, early reports showed most of the cases were related to an infectious process, most commonly syphilis or tuberculosis. A provisional diagnosis of Ludwig’s Angina with a differential diagnosis of non-Hodgkin’s Lymphoma and Tuberculous lymphadenitis was entertained She was treated presumptively with Ceftriaxone and Gentamycin. Her recent CD-4 count was 693 cells/mm3 She was admitted to the antepartum ward for observation with the provisional diagnosis of superior vena cava syndrome secondary to either Non Hodgkin Lymphoma or TB adenitis (scrofula), or Ludwig’s Angina.
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