An unusual case of non-malignant superior vena cava obstruction

YY Lam, JYS Chan
Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong

An 81-year-old Chinese woman presented with a 1-week history of increasing facial puffiness. She had 2:1 second-degree heart block and a permanent pacemaker that had been inserted 3 years previously because of syncopal episodes. Physical examination revealed facial plethora, dilated upper trunk veins, and oedematous upper limbs suggestive of superior vena cava obstruction syndrome. This was confirmed on urgent computed tomographic scan of the thorax. There was no evidence of extrinsic compression or formation of intraluminal thrombus. The underlying aetiology was a pacemaker-induced fibrotic stricture that was successfully treated with balloon venoplasty. At 3-month follow-up, the patient remained symptom-free with normal pacemaker function.

Hong Kong Med J 2006;12:232-4

Key words: Balloon dilatation; Pacemaker, artificial; Superior vena cava syndrome