What is the diagnosis for a patient with shortness of breath (SOB) and swelling of the head and neck, accompanied by weight loss, in a smoker?

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Last updated: March 30, 2025 • View editorial policy

Differential Diagnosis for SOB with Head and Neck Swelling and Weight Loss in Smoker

  • Single most likely diagnosis + Lung Cancer with Superior Vena Cava (SVC) Syndrome: This is the most likely diagnosis given the combination of shortness of breath (SOB), head and neck swelling, and weight loss in a smoker. Lung cancer is a common cause of SVC syndrome, which occurs when a tumor compresses the superior vena cava, leading to facial, neck, and upper limb swelling.
  • Other Likely diagnoses + Metastatic Cancer with Lymphadenopathy: Metastatic cancer to the lymph nodes in the neck can cause swelling and weight loss, and if the cancer involves the lungs, it can also cause SOB. + Thyroid Cancer with Mediastinal Involvement: Thyroid cancer can cause neck swelling and weight loss, and if it involves the mediastinum, it can compress the trachea and cause SOB. + Lymphoma with Mediastinal Involvement: Lymphoma can cause lymphadenopathy in the neck, weight loss, and if it involves the mediastinum, it can compress the trachea and cause SOB.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.) + Pulmonary Embolism (PE) with Septic Emboli: Although less likely, PE with septic emboli can cause SOB, weight loss, and if the emboli involve the head and neck, it can cause swelling. + Infectious Causes (e.g., Tuberculosis, Histoplasmosis): Infectious causes can cause weight loss, SOB, and head and neck swelling, especially in immunocompromised patients.
  • Rare diagnoses + Sarcoidosis with Pulmonary and Mediastinal Involvement: Sarcoidosis is a rare disease that can cause lung and mediastinal involvement, leading to SOB, weight loss, and head and neck swelling. + Castleman Disease with Pulmonary and Mediastinal Involvement: Castleman disease is a rare lymphoproliferative disorder that can cause lymphadenopathy, weight loss, and if it involves the mediastinum, it can compress the trachea and cause SOB.

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