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    Not Feeling Swell: Superior Vena Cava (SVC) Syndrome Falsely Attributed to COVID-19 Vaccine Reaction

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    Author
    McNeilly, Bryan P.
    Wilkerson, R. Gentry
    Date
    2022-01-01
    Journal
    Journal of Emergency Medicine
    Publisher
    Elsevier
    Type
    Article
    
    Metadata
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    See at
    https://doi.org/10.1016/j.jemermed.2022.01.031
    Abstract
    Background: The mass immunization campaign against Coronavirus disease 2019 (COVID-19) has resulted in more patients presenting to the emergency department (ED) with concern for a vaccine reaction. Case Report: A 68-year-old man presented to the ED reporting an allergic reaction to the COVID-19 vaccine. He initially noted swelling of his face, neck, and right arm after receiving the first dose of the vaccine. After his second dose of the vaccine, the swelling became more pronounced and prompted him to seek care. On examination, he had fullness of the neck and engorgement of the left external jugular vein, which were exacerbated when the patient raised his arms above his head, consistent with Pemberton's sign. Apart from the swelling of the head and neck, there were no other findings consistent with an allergic reaction. The presence of Pemberton's sign prompted a computed tomography scan of the chest with contrast, which revealed a paratracheal mass measuring 4.5 × 2.0 cm with marked narrowing of the superior vena cava (SVC). The patient was admitted to the hospital for SVC syndrome, and further workup revealed a non-small cell lung cancer. Why Should an Emergency Physician Be Aware of This?: Patients may misattribute their symptoms to a COVID vaccine reaction when they are, in fact, experiencing a more serious underlying disease. This case highlights the importance of a thorough physical examination and maintaining a broad differential diagnosis. In this case, the presence of Pemberton's sign raised suspicion for SVC syndrome, and prompted further workup. © 2022
    Keyword
    COVID-19
    non-small cell lung cancer
    Pemberton's sign
    SVC syndrome
    vaccine reaction
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/19570
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.jemermed.2022.01.031
    Scopus Count
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    UMB Coronavirus Publications
    UMB Open Access Articles

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