Superior vena cava obstruction in a patient with chronic lymphocytic leukemia and lung cancer

A patient with cervical lymphadenopathy secondary to chronic lymphocytic leukemia (CLL) developed acute superior vena cava (SVC) obstruction. Poor response to chemotherapy, a history of smoking, and lobar atelectasis suggested a different diagnosis. Bronchoscopy established the presence of a bronchogenic adenocarcinoma of the right lung as the etiology of the obstruction. Based on our experience and a review of the literature, we recommend that if a patient with CLL or a diffuse well-differentiated lymphocytic lymphoma presents with or develops SVC obstruction, additional invasive diagnostic tests must be initiated to exclude the possibility of a coexistent second malignancy or a transformation to a higher grade lymphoma. Other features warranting a search for another diagnosis are lack of the expected response to glucocorticoids, chemotherapy, or radiation therapy.