PT  - JOURNAL ARTICLE
AU  - Wen Shen Looi
AU  - Si Hui Goh
AU  - Colin Jingxian Tan
AU  - Kheng Wei Yeoh
AU  - Michaela Su-Fern Seng
TI  - Adolescent with facial swelling
AID  - 10.1136/archdischild-2019-317654
DP  - 2019 Oct 22
TA  - Archives of disease in childhood - Education & practice edition
PG  - edpract-2019-317654
4099  - http://ep.bmj.com/content/early/2019/10/22/archdischild-2019-317654.short
4100  - http://ep.bmj.com/content/early/2019/10/22/archdischild-2019-317654.full
AB  - 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.QuestionsWhat is the most likely diagnosis?Superior vena cava syndromeAngioedemaAnasarcaDiphtheriaDescribe the chest X-ray (figure 2).What are the acute concerns?What investigations would you order?Figure 2 Chest X-ray of the patient at presentation.QuestionsAnswers can be found on page 02.