A 60 year old male presented to the emergency with breathlessness, facial swelling and dilated veins on the chest wall. The most common cause is:

Answer is D (Superior Vena cava obsuction) : The patient in question is presenting with classical signs and symptoms of superior mediastinal syndrome or Superior vena caval syndrome. Lung cancer is the commonest cause of superior vana caval syndrome or SVC obstruction. As the options provided include superior vena caval obstruction as a distinct entity, it is the option of choice. Clinical manifestations of obstruction to SVC : Symptoms Signs * Swelling around neck & face especially around the eyes * Dilated neck veins * Dyspnea * Increased number of collateral veins over * Cough * anterior chest wall * Others: Hoarseness / Headache / Tongue * Cyanosis swelling / Nasal congestion / Epistaxis * Edema of face, arms & chest Haemoptysis / Dysphagia / Pain / * Proptosis, glossal and Laryngeal edema and obtundation in Dizziness / Syncope severe cases Symptoms are aggrevated by bending forwards and lying down.