Pleural effusion associated with superior vena cava syndrome: a rare cause of transudative chylothorax

Superior vena cava syndrome interrupts normal venous return of blood from the head, upper extremities and thorax. It may result from primary intrathoracic or metastatic malignancies. Approximately two thirds of the patients who have metastatic malignancies have breast cancer. In our case, a 64-year-old woman with history of breast cancer developed dyspnea and pleural effusion. Thoracentesis yielded a diagnosis of chylothorax and a computer tomography suggested a malignant extrinsic compression of the superior vena cava (SVC). This was successfully treated with angioplasty and stenting of the SVC. Chylothorax is an uncommon etiology for transudative pleural effusion, and it must be considered in the setting of central venous instrumentation or obstruction. Management for SVC syndrome associated with malignant condition involves both treatment of the cancer and relief of the obstructive symptoms.