Superficial venous collateral veins in superior vena cava syndrome

A 65-year-old male smoker presented with non-productive cough, fatigue, worsening dyspnea on exertion, hoarseness, and a six-month history of progressively enlarging veins over the anterior chest wall. Chest imaging study showed a right-sided superior sulcus (Pancoast) tumor that was compressing the superior vena cava with a serpentine-shaped posterior extension impinging upon the sympathetic chain, phrenic nerve (impairing diaphragmatic motility contributing to the dyspnea), and recurrent laryngeal nerve. Biopsy confirmed a bronchogenic adenocarcinoma.