Case report Bilateral pleural effusions in a 23-year-old man: a clinical puzzle

A 23-year-old man presented with progressive swel-ling in the left supraclavicular area and worsening dyspnea of 7 days duration. Histories of fever, chills, night sweats, cough or weight loss was denied. Medical and family histories were unremarkable. Physical examination revealed usage of accessory muscles of respiration, facial plethora, acne, mul-tiple dilated veins on chest wall, firm non-tender bilateral supraclavicular lymph nodes and decreased air entry and dullness in both lung bases. Chest X-ray revealed bilateral pleural effu-sions (Figure 1A). Computed tomography (CT) scan of the neck and chest demonstrated thrombotic oc-clusion of the superior vena cava, right subclavian, innominate and internal jugular veins, mediastina