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Adolescent with facial swelling
  1. Wen Shen Looi1,
  2. Si Hui Goh2,
  3. Colin Jingxian Tan3,
  4. Kheng Wei Yeoh1,
  5. Michaela Su-Fern Seng4
  1. 1 Radiation Oncology, National Cancer Centre Singapore, Singapore
  2. 2 Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore
  3. 3 Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore
  4. 4 Paediatric Hematology/Oncology Service, KK Women’s and Children’s Hospital, Singapore
  1. Correspondence to Dr Wen Shen Looi, Radiation Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore; looi.wen.shen{at}


Background A previously well 15-year-old girl presented with a 2-month history of facial swelling that progressively worsened to involve the neck. There was associated dyspnoea, orthopnoea, headache and throat discomfort. Two weeks before presentation, the patient had an episode of fever for 5 days. On examination, vital signs were within normal limits. Swelling, plethora and venous distension of the face and neck were apparent (figure 1).

Figure 1

(A) Patient before the onset of symptoms. (B) Patient at presentation.


  1. What is the most likely diagnosis?

    1. Superior vena cava syndrome

    2. Angioedema

    3. Anasarca

    4. Diphtheria

  2. Describe the chest X-ray (figure 2).

  3. What are the acute concerns?

  4. What investigations would you order?

Figure 2

Chest X-ray of the patient at presentation.

Questions Answers can be found on page 02.

  • adolescent health
  • oncology
  • paediatric practice

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  • Contributors Conceptualisation and design of the study: WSL and SHG. Drafting the manuscript: WSL and SHG. Revising the manuscript: WSL, SHG, MSFS, KWY, CTJ.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.