Pacemaker-Associated Superior Vena Cava Syndrome

   This image-based case report describes a 75-year-old man with facial erythema initially suspected as a drug reaction to mirtazapine. On further evaluation, he reported progressive swelling of the face and arms, dizziness with positional changes, and had a history of pacemaker implantation for sick sinus syndrome, with lead replacement two years prior. Physical examination revealed facial and neck edema, lip cyanosis, anterior chest wall varicosities, arm swelling, and distended jugular veins. CT venography showed complete upper superior vena cava (SVC) occlusion due to thrombus surrounding transvenous pacemaker leads and extensive venous collateralization. He was treated with intravenous heparin and subsequently underwent pacemaker removal and leadless system implantation. His symptoms resolved rapidly post-procedure. The case highlights superior vena cava syndrome as a rare complication of chronic pacemaker leads and the utility of cross-sectional imaging in diagnosis.

   This image-based case report describes a 75-year-old man with facial erythema initially suspected as a drug reaction to mirtazapine. On further evaluation, he reported progressive swelling of the face and arms, dizziness with positional changes, and had a history of pacemaker implantation for sick sinus syndrome, with lead replacement two years prior. Physical examination revealed facial and neck edema, lip cyanosis, anterior chest wall varicosities, arm swelling, and distended jugular veins. CT venography showed complete upper superior vena cava (SVC) occlusion due to thrombus surrounding transvenous pacemaker leads and extensive venous collateralization. He was treated with intravenous heparin and subsequently underwent pacemaker removal and leadless system implantation. His symptoms resolved rapidly post-procedure. The case highlights superior vena cava syndrome as a rare complication of chronic pacemaker leads and the utility of cross-sectional imaging in diagnosis.