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Question: A 70-year-old smoker presents with a four-week history of dyspnea, cough, and facial swelling that is exacerbated by bending forward. A physical examination reveals venous collaterals on the chest wall, and imaging is ordered. What is the most likely cause?

A. Right-sided heart failure

B. Superior vena cava obstruction

C. Pericardial effusion

D. Lymphatic obstruction

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Details: The answer is superior vena cava obstruction. Superior vena cava (SVC) syndrome is a group of findings caused by obstruction of the SVC. Symptoms are typically a result of an underlying malignancy in the mediastinum or thrombosis within the SVC. When blood flow is constricted, venous pressure is elevated and collaterals form in an effort to redirect the flow. Management of SVC syndrome is dependent on the underlying disease and may include surgery, radiation, chemotherapy, or thrombolytic therapy.

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