SESSION TITLE: Disorders of the Mediastinum 1 SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Superior Vena Cava (SVC) obstruction can occur due to malignant etiologies or benign causes including endovenous devices like central catheters. We present a case of persistent erythematous facial edema secondary to catheter associated SVC obstruction. CASE PRESENTATION: A 53 year old female with stage IV colon cancer treated by means of resection and chemotherapy via a left internal jugular vein (IJV) port developed catheter associated SVC thrombosis two years prior to presentation. Despite anti-coagulation with a direct factor Xa inhibitor, she had progression of the clot requiring removal of the port followed by insertion of a femoral port which later became infected. She then had a new port inserted from the right IJV. She presented with persistent facial swelling and plethora, headache and dizziness. She had numbness and tingling of her extremities. She had recently experienced transient left-sided upper and lower extremity weakness during a chemotherapy session. On physical examination, her vital signs were normal. She had significant swelling of the face and fullness in her neck along with facial plethora (Figure 1A). The laboratory parameters were normal. Computed tomography of chest demonstrated complete occlusion of the SVC distal to the origin of a hypertrophied azygos to the right atrium (Figure 1B). The tip of the right sided port terminated in the hypertrophied azygos. The first attempt at percutaneous wire recanalization of the SVC was unsuccessful. Due to persistent SVC syndrome and need for maintenance of long term venous access, she underwent a successful sharp recanalization of SVC and stent graft placement followed by placement of a right-sided IJV port with the catheter extending through the stent into the right atrium (Figure 2). The patient reported immediate decrease in facial swelling after the procedure and was discharged on long term anticoagulation therapy with low molecular weight heparin. DISCUSSION: Patients with SVC obstruction from benign causes often present with symptoms that can be confused with other etiologies. In a patient with history of vascular access procedures these symptoms, especially facial swelling, should prompt consideration of SVC obstruction. Once clinically detected, appropriate use of imaging can identify cause and location of SVC obstruction and facilitate treatment. Conventional percutaneous endovascular recanalization techniques are relatively safe and have good long-term patency1. CONCLUSIONS: Symptoms of catheter related thrombosis can be subtle or present as a more serious complication, such as SVC obstruction. There should be a low threshold to perform diagnostic work up for thrombus even in a port that appears to be working, as early intervention can have substantial impact on patient’s morbidity. Reference #1: Breault, S., et al. (2017). “Percutaneous endovascular management of chronic superior vena cava syndrome of benign causes : long-term follow-up.“ Eur Radiol 27(1): 97-104. DISCLOSURE: Cristhiam Rojas Hernandez: Grant monies (from industry related sources): Daichii Sankyo (research funding) The following authors have nothing to disclose: Yameena Jawed, Rahul Sheth, Joshua Kuban No Product/Research Disclosure Information