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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The differential diagnosis of facial edema and erythema is broad and includes diseases with variable outcome that may require urgent attention&#46; We report 2 cases of patients in whom these clinical symptoms were signs of neoplastic disease&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The first patient is a 59-year-old woman with a past history of breast and lung cancer 6 years earlier&#44; who presented palpebral and facial erythema and edema that had appeared 1 month earlier&#46; The patient was being studied due to a probable angioedema and was receiving treatment with topical corticosteroids and antihistamines&#44; with gradual worsening of the condition&#46; The physical examination revealed an edema in the cervical region and upper chest&#44; together with collateral circulation &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Computed tomography of the chest revealed an infiltrating mass enclosing and constricting the superior vena cava &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Subsequent studies confirmed a recurrence of the patient&#8217;s lung cancer&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The second patient is a 69-year-old woman with a past history of allergic rhinitis&#44; who visited the emergency department with a palpebral and facial edema that had appeared 15 days earlier&#46; She had undergone treatment with oral corticosteroids and antihistamines due to suspected angioedema&#44; with no response&#46; She reported weight loss of 5&#8239;kg in 6 months and stated that she was a smoker&#46; Physical examination revealed edema of the face and neck&#44; and right jugular vein distention &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; A chest x-ray showed a hilar mass causing complete atelectasis of the right upper lobe 1B&#41;&#46; Computed tomography of the chest confirmed a mediastinal infiltrate and obstruction of the superior vena cava&#46; Subsequent studies confirmed the diagnosis of lung cancer&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">In superior vena cava syndrome &#40;SVCS&#41;&#44; vascular infiltration by a mass &#40;most frequently tumor&#41; obstructs venous flow to the right atrium and causes gradual edema of the face and upper extremities&#44; and may be associated with reddening&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> Distention of veins in the torso and neck&#44; which worsens in the supine position&#44; makes it possible to differentiate it from other diseases&#46; Imaging tests usually confirm the diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> This is an entity in which signs on the skin may indicate an internal tumor&#44; as also occurs with other cutaneous manifestations in the context of lung cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In the 2 patients described&#44; the first diagnosis was angioedema&#44; a sudden inflammation of the skin&#44; subcutaneous tissue&#44; or mucosa due to increased capillary permeability&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> Facial edema&#44; however&#44; usually persists for weeks and does not respond to antihistamines&#46; It is not usually due to angioedema&#46; Nevertheless&#44; we have found this incorrect diagnosis of angioedema in SVCS repeated in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Diagnostic failure in SVCS can lead to inappropriate treatment of the real disease&#44; which may be severe in some cases&#44; as in those reported here&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Other entities to consider in the differential diagnosis include dermatomyositis&#44; which was another of the principal suspected diseases in the first case described and which was the reason for performing a skin biopsy and myositis antibody assay&#44; with no findings&#46; Heliotrope rash&#44; shawl sign&#44; and their potentially paraneoplastic nature may be similar to SVCS&#46; But the other manifestations&#44; such as myositis and Gottron papules&#44; may help to differentiate it&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Other entities that should be considered due to their potential to cause facial erythema or edema include acute contact dermatitis&#44; which typically affects the skin surface&#44; and exanthema caused by drug reaction with eosinophilia and systemic symptoms &#40;DRESS&#41;&#44; in which skin involvement tends to be generalized&#46; These and other diseases that rarely produce facial edema &#40;such as rosacea&#44; hypothyroidism&#44; subcutaneous emphysema&#44; orofacial granulomatosis&#44; urticaria&#44; hypocomplementemic vasculitis&#44; systemic capillary leak syndrome&#44; and histaminergic headache&#41; must be considered in the differential diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In conclusion&#44; we report 2 patients with SVCS secondary to a tumor&#44; which illustrate the importance of considering this syndrome in the differential diagnosis of facial or cervical edema&#44; in which a thorough patient history and complete examination are essential&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Case and Research Letters
Superior Vena Cava Syndrome
Síndrome de vena cava superior
A. Tomás-Velázqueza,
Autor para correspondencia
atomasv@unav.es

Corresponding author.
, P.L. Quan Lópezb, M. Calvo Imirizalduc, A. España Alonsoa
a Departamento de Dermatología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
b Departamento de Alergología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
c Departamento de Radiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical images&#46; A&#44; Periocular and bimalar edema and erythema&#46; B and C&#44; Edema of the face and neck&#44; notable in the cervical and clavicular regions&#46; D&#44; Collateral venous circulation in the region of the sternum&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The differential diagnosis of facial edema and erythema is broad and includes diseases with variable outcome that may require urgent attention&#46; We report 2 cases of patients in whom these clinical symptoms were signs of neoplastic disease&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The first patient is a 59-year-old woman with a past history of breast and lung cancer 6 years earlier&#44; who presented palpebral and facial erythema and edema that had appeared 1 month earlier&#46; The patient was being studied due to a probable angioedema and was receiving treatment with topical corticosteroids and antihistamines&#44; with gradual worsening of the condition&#46; The physical examination revealed an edema in the cervical region and upper chest&#44; together with collateral circulation &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Computed tomography of the chest revealed an infiltrating mass enclosing and constricting the superior vena cava &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Subsequent studies confirmed a recurrence of the patient&#8217;s lung cancer&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The second patient is a 69-year-old woman with a past history of allergic rhinitis&#44; who visited the emergency department with a palpebral and facial edema that had appeared 15 days earlier&#46; She had undergone treatment with oral corticosteroids and antihistamines due to suspected angioedema&#44; with no response&#46; She reported weight loss of 5&#8239;kg in 6 months and stated that she was a smoker&#46; Physical examination revealed edema of the face and neck&#44; and right jugular vein distention &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; A chest x-ray showed a hilar mass causing complete atelectasis of the right upper lobe 1B&#41;&#46; Computed tomography of the chest confirmed a mediastinal infiltrate and obstruction of the superior vena cava&#46; Subsequent studies confirmed the diagnosis of lung cancer&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">In superior vena cava syndrome &#40;SVCS&#41;&#44; vascular infiltration by a mass &#40;most frequently tumor&#41; obstructs venous flow to the right atrium and causes gradual edema of the face and upper extremities&#44; and may be associated with reddening&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> Distention of veins in the torso and neck&#44; which worsens in the supine position&#44; makes it possible to differentiate it from other diseases&#46; Imaging tests usually confirm the diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> This is an entity in which signs on the skin may indicate an internal tumor&#44; as also occurs with other cutaneous manifestations in the context of lung cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In the 2 patients described&#44; the first diagnosis was angioedema&#44; a sudden inflammation of the skin&#44; subcutaneous tissue&#44; or mucosa due to increased capillary permeability&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> Facial edema&#44; however&#44; usually persists for weeks and does not respond to antihistamines&#46; It is not usually due to angioedema&#46; Nevertheless&#44; we have found this incorrect diagnosis of angioedema in SVCS repeated in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Diagnostic failure in SVCS can lead to inappropriate treatment of the real disease&#44; which may be severe in some cases&#44; as in those reported here&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Other entities to consider in the differential diagnosis include dermatomyositis&#44; which was another of the principal suspected diseases in the first case described and which was the reason for performing a skin biopsy and myositis antibody assay&#44; with no findings&#46; Heliotrope rash&#44; shawl sign&#44; and their potentially paraneoplastic nature may be similar to SVCS&#46; But the other manifestations&#44; such as myositis and Gottron papules&#44; may help to differentiate it&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Other entities that should be considered due to their potential to cause facial erythema or edema include acute contact dermatitis&#44; which typically affects the skin surface&#44; and exanthema caused by drug reaction with eosinophilia and systemic symptoms &#40;DRESS&#41;&#44; in which skin involvement tends to be generalized&#46; These and other diseases that rarely produce facial edema &#40;such as rosacea&#44; hypothyroidism&#44; subcutaneous emphysema&#44; orofacial granulomatosis&#44; urticaria&#44; hypocomplementemic vasculitis&#44; systemic capillary leak syndrome&#44; and histaminergic headache&#41; must be considered in the differential diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In conclusion&#44; we report 2 patients with SVCS secondary to a tumor&#44; which illustrate the importance of considering this syndrome in the differential diagnosis of facial or cervical edema&#44; in which a thorough patient history and complete examination are essential&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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