Acute lymphoid leukemia presenting with superior vena cava syndrome
A 30-year-old man was admitted to Alzahra hospital, Isfahan, Iran in January, 2012, because of dyspnea and facial edema.\nThe patient had been well until 4 days before admission, when sudden onset dyspnea and orthopnea developed. He was afebrile and without sore throat. He reported any weight loss during the previous months. Medications included Brome hexin syrup, Theophylin and antihistamins without any effects.\nOn examination, the blood pressure was 120/80 mm Hg, the pulse 80 beats per min, the temperature 37°C, the respiratory rate 16 breaths per minute, the oxygen saturation 92% while the patient was breathing ambient air, and the weight 80 kg. The patient was using intercostal muscles of chest wall during respiration. A variceal vein was seen on upper chest and neck. The remainder of the examination was normal.\nResults of a complete blood count blood levels of urea nitrogen, albumin, total and direct bilirubin, creatine kinase, prothrombin time (PT), activated partial thromboplastin time (aPTT), international normalized ratio (INR), aspartate aminotransferase and arterial blood gas were normal. A urinalysis was normal. An electrocardiogram showed sinus rhythm at a rate of 90 beats per min, without any problem. In echocardiography left ventricular ejection fraction was 55% and other finding was normal. In analysis, PaO2 and PH were normal (60 mmHg, 7.42 respectively). A chest radiograph was done as . Thoracic Computed tomography (CT) with Intravenous contrast performed as illustrate in . In order to reducing his respiratory symptoms and improving respiratory distress, the patient received intravenous Corticosteroid (Dexamethasone 8 mg 3 times a day for 3 days.). Transthoracic mediastinal biopsy was done and in pathologic report lymphoblastic lymphoma was reported. Immunohistochemistry revealed leukocyte common antigen (LCA) and Terminal deoxynucleotidyl transferase (TdT) positive.\nTreatment with hyper cyclophosphamide, vincristin, adriamycine, dexamethasone (CVAD) regimen[] done and respiratory symptoms resolved after 5 days completely. Patient was selected for bone marrow transplantation.