Refractory rhinorrhoea secondary to superior vena cava syndrome

Abstract

Superior vena cava (SVC) syndrome is a collection of clinical signs and symptoms resulting from either partial or complete obstruction of blood flow through the SVC. This obstruction is most commonly a result of thrombus formation or tumour infiltration of the vessel wall. Incidence of SVC syndrome, post haemodialysis catheter insertion, is about 5% to 19 %, however, with regards to refractory rhinorrhoea secondary to SVC syndrome, this is the first case report in medical literature. Common symptoms of SVC syndrome are facial puffiness, upper limb oedema, hoarseness of voice, cough and rarely, bilateral reversible hearing loss and cerebrospinal fluid (CSF) rhinorrhoea. Here, we present a case of refractory rhinorrhoea and bilateral conductive hearing loss in a patient with SVC syndrome which resolved immediately after relieving the SVC obstruction. There is extreme paucity of data regarding refractory rhinorrhoea as manifestation of SVC syndrome and hence should always be considered in differential diagnosis, with predisposing thrombotic background. This case also highlights the limitations of radiological procedure and timely surgical intervention in SVC syndrome.