What happened, in summary

This 59-year-old woman came to the emergency department with worsening headaches, shortness of breath, and swelling of the face and both arms over 2 weeks. Her medical history included diabetes mellitus, coronary artery bypass grafting, and cocaine abuse. Examination showed diffuse facial swelling and bilateral upper-extremity swelling, while routine laboratory tests were largely unremarkable. CT pulmonary angiography revealed a right suprahilar mass measuring about 5.2 × 5.1 cm. The mass severely compressed a right upper-lobe pulmonary artery branch and caused severe short-segment narrowing of the superior vena cava, or SVC. The scan also showed left upper- and lower-lobe segmental and subsegmental pulmonary emboli without right-heart strain. A heparin drip was started, and interventional radiology was consulted. Venography confirmed severe SVC stenosis caused by the infiltrating right suprahilar mass. During the procedure, an intravascular biopsy of the mass was obtained using the HawkOne system. A 12 mm × 6 cm Abre stent was then placed across the SVC stenosis below the brachiocephalic vein confluence, with its distal portion near the cavoatrial junction. In-stent venoplasty followed using 12 mm and 14 mm balloons. Immunostaining from the mass was positive for synaptophysin, chromogranin, CD56, TTF1, and BCL-2, consistent with small cell lung cancer. She was transitioned to a direct oral anticoagulant and discharged with near-full symptom resolution. As of June 2024, outpatient oncology follow-up was planned for newly diagnosed SCLC. No systemic chemotherapy or radiation had been started during the reported hospitalization, so cancer-directed treatment was deferred to outpatient care after discharge by oncology.