[Patients with superior vena cava syndrome: pitfalls in recognition]

Superior vena cava syndrome (SVCS) may be the presenting sign of malignancy. SVCS may be difficult to recognize due to its usual slow development or possible temporary regression. We discuss the pitfalls in recognizing SVCS by presenting two cases. In a 45-year-old man, facial swelling diminished after he was administered intraarticular steroids to treat brachialgia. During the same period, collateral veins appeared on his chest wall. Only a few weeks later he was diagnosed with SVCS due to lung cancer. A 31-year-old man with a swollen face was treated with glucocorticoids, allegedly for an allergic reaction. When symptoms recurred after one week, it was discovered that SVCS was caused by lymphoma. These cases illustrate that the first manifestations of SVCS may be subtle and that development of collaterals or the use of glucocorticoids may relieve symptoms. Importantly, late diagnosis of SVCS results in delay of treatment of the underlying cause, which is often malignant.