Concurrent Cardiac Tamponade and Superior Vena Cava Syndrome: A Concerning Situation

Abstract

Diffuse large B-cell lymphoma (DLBCL) is the most commonly diagnosed lymphoma; as per the Surveillance, Epidemiology, and End Results (SEER) database 2006-2015, incidence of DLBCL is 7.0/100,000 per year. Superior vena cava (SVC) syndrome and cardiac tamponade are lifethreatening oncological emergencies with an overlap in clinical manifestations. While SVC syndrome may commonly be seen with mediastinal masses, literature search shows only one prior case of cardiac tamponade resulting from DLBCL. Here, we present a case of a patient with a concurrent diagnosis of DLBCL and non-small cell carcinoma of the lung (NSCLC), presenting with respiratory symptoms initially but subsequently worsening with hemodynamic compromise. He was found to have cardiac tamponade secondary to DLBCL and was treated appropriately for it but failed to improve clinically due to co-existing SVC syndrome that was not treated. The patient expired in the intensive care unit (ICU) within 24 hours of acute clinical deterioration. This case highlights that in absence of a clinical suspicion for both conditions, identification of one can lead to an overlooked diagnosis of the other. When associated with hemodynamic instability, urgent intervention is mandatory and failure to recognize and treat either of the two may result in grave outcome. This case attempts to alert medical personnel regarding two major oncological emergencies where an accurate diagnosis and urgent intervention can prevent mortality and morbidity.