A 68-year-old woman with hoarseness and upper airway edema

After presenting for evaluation of hoarseness and dysphagia, a 68-year-old woman was found to have a right lung mass on chest computed tomography. Although she had normal airway anatomy during laryngoscopy 2 days earlier, she was noted to have marked upper airway edema during bronchoscopy, such that endobronchial ultrasound -- guided biopsies were aborted due to an inability to safely advance the bronchoscope into the upper airway. This patient developed upper airway obstruction due to superior vena cava (SVC) syndrome. The majority of cases of SVC syndrome are due to mediastinal malignancies, most often SCLC and non-Hodgkin's lymphoma. Common symptoms include swelling in the face, neck, or upper extremities, headache, and nasal congestion. Common signs include facial plethora, distended neck veins, and upper extremity edema. Less commonly, patients present with airway edema and impending respiratory failure, and cardiovascular or neurological compromise. These patients often require endovascular stenting, followed by radiation therapy and parenteral corticosteroids.