Anterior Mediastinal Mass Leading to Superior Vena Cava Obstruction- A case report

Abstract

Anterior mediastinal masses are uncommon but potentially life-threatening, particularly when they cause vascular compromise such as superior vena cava (SVC) obstruction. Thymoma is the most frequently encountered anterior mediastinal tumour in adults and may produce critical complications including complete SVC occlusion, haematological toxicity, and post-treatment pulmonary sequelae.

CASE PRESENTATION: A 53-year-old woman from Gilgit Baltistan presented with a 20-day history of fever and cough. Contrast-enhanced computed tomography of the chest revealed a large infiltrative anterior mediastinal mass encasing the great vessels and causing complete SVC obstruction with significant collateral venous formation. She was treated with concurrent chemoradiotherapy (CCRT), with serial imaging demonstrating partial tumour regression. However, persistent SVC obstruction, post-radiation pulmonary fibrosis, and progressive haematological toxicity — including dimorphic anaemia, leucopenia, and thrombocytopenia — developed as sequelae of treatment. This case highlights the importance of early imaging evaluation, a multidisciplinary treatment approach, and diligent haematological surveillance in patients with anterior mediastinal masses complicated by SVC obstruction. Holistic nursing care addressing both the physical and psychosocial burden of long-term malignancy is equally essential to optimise patient outcomes.