Clinical picture Superior vena cava syndrome related fluid collection in retropharyngeal space

A 44-year-old male smoker presented with productive cough, sore throat and dyspnea for 2 weeks. He had no fever but had lost about 8 kg in body weight in the recent 2 months. He was referred to a tertiary hospital where a physical examination revealed face, neck and right arm swelling. A chest plain film showed right upper lung consolidation and upper mediastinal widening (Figure 1). Chest computed tomography (CT) showed a right hilarmediastinal large lobulated and confluent mass, measuring 10.7 9.5 12.0 cm. The lesion resulted in nearly complete obstruction of the superior vena cava (SVC) and an increase in mediastinum collateral circulation (Figure 2). A CT-guided biopsy of the tumor was performed, and a pathological examination revealed a picture of small cell carcinoma. Immunohistochemical analysis of the tumor revealed positive chromogranin A and synaptophysin staining. Due to the patient’s sore throat, neck CT was done which revealed a long fusiform retropharyngeal space fluid collection, ranging from the first to fifth cervical spine level (Figure 3). The patient then received CT-guided fine-needle aspiration of the retropharyngeal fluid. Gram’s stain and culture of the aspirated fluid revealed no evidence of infection. The cytological examination of the fluid was also negative for malignancy. He received a cycle of chemotherapy with EP regimen (etoposide 70mg/m for Day 1 to Day 3, and cisplatin 70mg/m for Day 1), and size of the tumor gradually decreased. Follow-up imaging showed no further retropharyngeal fluid accumulation (Figure 4).