C80-42 Superior Vena Cava Syndrome Complicated by a High Grade Neuroendocrine Tumor and Histoplasmosis

Abstract Introduction Superior Vena Cava Syndrome (SVC) is characterized by obstruction of the superior vena cava, ultimately preventing blood flow to the heart. Typical presentations of SVC syndrome include severe dyspnea, facial plethora and neurological disturbances. SVC is most often caused by malignancies such as lung cancer or non-Hodgkin’s lymphoma, but may also be a result of infections like tuberculosis and histoplasmosis, mediastinal fibrosis, and pacemaker or catheter-related thrombosis. SVC develops in roughly 2-4% of total lung cancer cases and in 10% of small cell lung cancer cases, making it a rare life-threatening complication requiring urgent intervention. Case Presentation A 63-year-old caucasian male with a 0.5 pack-per-day smoking history presented to the emergency department with progressive dyspnea and swelling of the face and neck, noting an onset of symptoms two weeks prior. His medical history was significant for eosinophilic esophagitis, esophageal dysmotility, and hypertension. He denied systemic symptoms such as fever, chills, and weight loss, but reported progressive orthopnea over the course of several months, making it difficult for him to lie flat. Upon physical examination, he was noted to have significant facial plethora and distention of his neck veins. He ultimately required a tracheostomy to establish an airway due to laryngeal mass. A computed tomographic angiography (CTA) of the chest revealed narrowing of the right and partial left main pulmonary arteries accompanied by soft tissue and upper airway swelling. Moreover, the CTA demonstrated concurrent central conglomerate lymphadenopathy measuring 13.2 x 14.5 cm. A subsequent ultrasound-guided biopsy by interventional radiology of a supraclavicular lymph node revealed a high-grade neuroendocrine tumor. Magnetic resonance imaging (MRI) of the brain was conducted and ultimately demonstrated no evidence of metastatic disease. A sputum culture confirmed the presence of a Histoplasma caspulatum infection. The patient was initiated on IV dexamethasone, antibiotics, antifungals, and inpatient chemotherapy to which he demonstrated a marked improvement in both his clinical signs and symptoms. Discussion This case demonstrates the complexities of the diagnosis and management of SVC, particularly in the face of an underlying malignancy. This patient demonstrated classic symptoms of SVC with additional complications of a highly opportunistic fungal infection and a high-grade neuroendocrine tumor. Additionally, it emphasizes the critical importance of timely diagnosis and therapeutic intervention in the presence of airway and vascular symptoms. Recent studies suggest poor prognostic implications of SVC in lung cancer, underscoring the need for further research into optimal therapeutic intervention strategies. This abstract is funded by: None