Superior vena cava syndrome of thrombotic etiology induced by pulmonary neoplasia: case report

Abstract

Objective: To present a clinical case of Superior Vena Cava Syndrome (SVCS) of mixed etiology, highlighting its rapid progression, diagnostic complexity, and therapeutic challenges in a setting with limited endovascular resources. Case details: A 63-year-old female patient with chronic obstructive pulmonary disease, Chagas cardiomyopathy, and hypertension presented with facial and upper-limb edema, dyspnea, and cervical fullness. Contrast-enhanced chest computed tomography revealed extensive thrombosis of the superior vena cava and both subclavian veins, along with a heterogeneous pulmonary mass suggestive of adenocarcinoma. Full anticoagulation with rivaroxaban was initiated without clinical improvement. Due to the unavailability of endovascular treatment, systemic thrombolysis with alteplase was attempted as a rescue measure, but no effective reperfusion was achieved, and the patient died of refractory shock. Histopathological examination confirmed primary pulmonary adenocarcinoma, establishing a diagnosis of SVCS of mixed (malignant and thrombotic) etiology. Final considerations: SVCS represents an oncological and hemodynamic emergency in which early diagnosis, clinical stratification, and rapid access to endovascular therapy are crucial for favorable outcomes. This case underscores the need for institutional protocols ensuring timely access to multidisciplinary interventions, particularly in rapidly evolving cases with overlapping thrombotic and neoplastic mechanisms.