Symptomatic Superior Vena Cava Lipoma Causing Near-Complete Venous Obstruction: A Case Report and Literature Review

Background

Lipomas are common benign mesenchymal tumors; however, intravascular localization is exceedingly rare. Superior vena cava (SVC) involvement represents an exceptional entity, with only a limited number of cases reported in the literature. Intravascular lipomas are frequently detected incidentally but may present with symptoms related to venous obstruction, including superior vena cava syndrome. We report a rare case of SVC-origin intravascular lipoma extending into the right brachiocephalic vein, accompanied by a focused review of previously published upper extremity cases.

Case Presentation

A 77-year-old male presented with facial and cervical edema, dyspnea exacerbated in the supine position, and distended cervical veins. Contrast-enhanced computed tomography revealed a 5-cm elongated, fat-attenuation mass within the SVC extending into the right brachiocephalic vein, causing near-total (approximately 99%) luminal occlusion. Transthoracic echocardiography supported the diagnosis. The patient underwent surgical resection via median sternotomy under cardiopulmonary bypass. Following longitudinal venotomy of the SVC extending to the brachiocephalic vein, the tumor—adherent to the posterior venous wall—was completely excised with preservation of vascular integrity. Primary venous repair was performed. The diagnosis of lipoma was histopathologically confirmed. The patient initially showed marked symptomatic improvement; however, on postoperative day 5, sudden-onset dyspnea necessitated reintubation, followed by multiorgan failure and death. The precise cause of the acute deterioration could not be definitively established.

Literature review identified only 21 previously reported upper extremity intravenous lipomas, with this case representing the 16th involving the SVC and the oldest reported patient.

Conclusion

Upper extremity intravenous lipomas are rare and may lead to significant venous obstruction. Cross-sectional imaging is essential for diagnosis and surgical planning. In symptomatic patients, complete surgical excision provides definitive treatment and symptom relief. Management of incidentally detected asymptomatic cases remains controversial and should be individualized.