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Adolescent with facial swelling


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.

QuestionsAnswers can be found on page 02.

  • adolescent health
  • oncology
  • paediatric practice
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