A 55-year-old woman smoker is seen in the emergency room (ER) complaining of several days of increasing facial fullness, orthopnea, and swelling in her neck and hands. Physical examination is notable for obvious facial swelling, with conjunctival edema, jugular venous distention, and symmetric swelling of both upper extremities. Fullness is present in both supraclavicular fossae, but there is no clear lymph node enlargement, and the lungs are clear. The patient is tachycardic, but no gallop, murmur, or rub is present. No hepato megaly, ascites, or pedal edema is present. Chest radiography reveals a right hilar mass. The patient is admitted to the hospital at midnight, and you order which of the following?
A. An emergency upper extremity venogram
B. An emergency computed tomography (CT) scan of the chest
C. An emergency echocardiogram (ECHO)
D. Diuretics and elevation of the head of the bed until the morning
Answer:D
A 55-year-old woman smoker is seen in the emergency room (ER) complaining of several days of increasing facial fullness, orthopnea, and swelling in her neck and hands. Physical examination is notable for obvious facial swelling, with conjunctival edema, jugular venous distention, and symmetric swelling of both upper extremities. Fullness is present in both supraclavicular fossae, but there is no clear lymph node enlargement, and the lungs are clear. The patient is tachycardic, but no gallop, murmur, or rub is present. No hepato megaly, ascites, or pedal edema is present. Chest radiography reveals a right hilar mass. The patient is admitted to the hospital at midnight, and you order which of the following?
A. An emergency upper extremity venogram B. An emergency computed tomography (CT) scan of the chest C. An emergency echocardiogram (ECHO) D. Diuretics and elevation of the head of the bed until the morning