Clinical Presentation

A 49-year-old woman with a history of metastatic breast cancer presents with facial swelling and shortness of breath.

(A) A contrast-enhanced computed tomographic (CT) scan shows soft-tissue masses (arrows) compressing the superior vena cava (SVC: arrowhead). (B) Venogram shows stenosis of the right brachiocephalic vein and SVC (arrows). (C) Venogram after stent placement shows resolution of the stenosis.

Differential Diagnosis

• Malignant superior vena cava syndrome: The most likely diagnosis, indicated by the clinical history and the masses compressing the SVC.
  
• Mediastinal fibrosis: May cause masslike soft-tissue infiltration of the mediastinum and SVC narrowing due to fibrosis.

Essential Facts