Superior Vena Cava Syndrome in a Case of Interstitial Lung Disease

Abstract

Abstract Superior vena cava (SVC) syndrome is mostly seen secondary to malignancies, while benign causes account for only 30% of cases. This case report is of a 62-year-old obese male diagnosed with interstitial lung disease (ILD) non specific interstitial pneumonia (NSIP) pattern on steroids for 1 year and antifibrotics for 3 months came with exacerbation of dyspnea, orthopnea, and nonproductive cough of 3 months duration. He had a facial plethora, watering of eyes, dilated veins over the chest, striae over the abdomen, and Grade 2 clubbing clinically suggestive of SVC obstruction. Contrast-enhanced computed tomography (CT) thorax revealed mediastinal lipomatosis compressing SVC and bilateral brachiocephalic veins. His steroids were tapered and stopped, and he was initiated on pioglitazone. Serum cortisol level was normal suggestive of exogenous Cushing’s disease. Repeat CT taken after 5 months showed reversal of SVC obstruction with no progression of ILD.