Unusual case of superior vena cava syndrome caused by intrav
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Superior cava venous obstruction use to show a typical clinical presentation and a CT scan or even a ultrasonography can be sufficient to achieve an accurate diagnosis, but in this case, to obtain the final diagnosis, a multimodal assessment is needed. This case report shows a multidisciplinary approach which helped diagnose a complicated case, where conventional diagnostic methods were not enough.

An 80-year-old woman presented to medical emergency with two days' history of edema in the left arm. As relevant medical history, she was diagnosed with a follicular thyroid cancer in 2003. A total thyroidectomy was performed, and she needed to be given two ablative doses of I131. In 2006, a superior lung lobectomy in the right side was carried out after the disease was detected in a PET study of that localization. Two years later, more metastatic lung disease was noticed, but with a slow growth. In 2009, after clear disease progression, sorafenib as a treatment was started. She has been taken this treatment for over 34 months until lung progression in 2012. At this time, the treatment with sorafenib was interrupted and a second-line treatment with sunitinib was initiated. Unfortunately, after two months of the therapy modification, the patient went through two necessary surgeries; the first one was precipitated by an intestinal occlusion by adhesions (she had a history of appendectomy) and the second one by an intestinal perforation...

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