Collateral Vascularization in Chronic Superior Vena Cava Syndrome

Abstract

A man in his mid-70s presented with distended superficial veins on the chest and abdomen (Figure A) ongoing for 3 months. Computed tomography of the chest with contrast medium revealed marked collateral vessels (Figure B) secondary to a mass in the mediastinum (Figure C) obstructing the superior vena cava (SVC) with associated thrombus (Panel C), consistent with chronic SVC syndrome. Biopsy identified lung adenocarcinoma, and subsequent imaging revealed widely metastatic disease. The patient was treated with palliative radiotherapy to the area of SVC obstruction in the mediastinum to a total dose of 30 Gy delivered in 10 fractions, followed by systemic therapy with pembrolizumab, carboplatin, and pemetrexed.