Non-malignant superior vena cava syndrome in a patient with incidental diagnosis of a congenital vascular defect

Description

An 81-year-old patient came to our clinic referred by his general practitioner to assess the distension of the veins in the neck and chest (figure 1). He was asymptomatic, except for the swollen collateral veins in the chest wall. He had no dyspnoea, cough or facial oedema. He had a several-year history of progressively enlarging veins over the anterior chest wall (since the age of 30 years), but he had never sought medical advice. The rest of the physical examination was normal. A chest CT scan showed a persistent left superior vena cava draining into the coronary sinus, chronic thrombosis of the right superior vena cava and venous collateral circulation in the chest (figure 2). The radiologist labelled the thrombosis as chronic, given the decreased venous diameter and the calcified, dense, heterogeneous thrombus.

Figure 1

On physical examination, the patient presented with venous...

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