A 67-year-old man consulted with the ophthalmologist for presenting in the last days pain in the right eye with blurred vision, incessant tear and diplopia in the extreme look.
The examination revealed ocular discomfort marked by profusion of the right eye, which presented generalized limitation to mobility, especially in the face of consolidation, and intense swelling of the conjunctiva that prolapsed through the cleft lip and palate.
After performing an orbital CT and ruling out intraorbital involvement, the patient was referred to Internal Medicine.
He was a male smoker of 30 cigarettes a day since his youth without any other relevant background.
In the anamnesis, besides the ocular symptoms that led to the consultation, she reported having presented some respiratory distress and dysphonia, but without chest pain, hemoptysis, fever or other systemic symptoms.
On physical examination her general condition was good and she had no signs of increased respiratory work.
In the physical examination, besides the alterations of the right eye, a striking increase in volume of the right side of the face and neck was observed.
The right jugular vein remained visible and engorged continuously and at the level of the right temple and anterior thoracic plane dilation of the superficial venous network could be appreciated.
The neck fixation showed a hard, adhered and non-painful tumor at the level of the right supraclavicular fossa.
Vital signs, axillary involvement, and pulmonary, cardiac, abdominal and lower limb examination showed no relevant findings.
Complete blood count, coagulation study, biochemical profile including tumor markers and arterial gas analysis were normal.
Chest X-ray showed mediastinal widening of the right hilum.
In the cervicothoracic CT, multiple nodular images were observed in the upper lobe of the right lung, adenopatic conglomerate occupying the anterior mediastinum and with cranial extension to the right lateral neck vein and jugular trunk.
Cranial-orbital CT showed mild right exophthalmos, thickening of the superior ophthalmic vein and absence of orbital tumor.
A needle aspiration biopsy of the right cervical adenopathic mass was diagnostic of metastasis of small cell carcinoma.
