A 72-year-old man presented with a 5-week history of exertional dyspnoea and facial swelling on a background of hypertension and previous coronary artery bypass graft (CABG) surgery for acute coronary syndrome (left internal mammary artery to left anterior descending/third diagonal branch and left radial artery to first obtuse marginal) 5 years prior. He denied any facial pain, headache or arm swelling. He was lost to follow-up following his coronary artery bypass graft (CABG) surgery. On clinical examination, the heart rate was 70 bpm and blood pressure was 160/90 mmHg. The patient was noted to be plethoric, with facial swelling and distended external jugular veins (Figure 1A). Carotid pulse was of normal character and without bruits. His heart sounds were dual with no added sounds or murmurs. Auscultation of his lungs did not reveal any abnormalities and there was no peripheral oedema.
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Published online: December 24, 2022
Accepted: November 20, 2022
Received in revised form: October 16, 2022
Received: July 8, 2022
© 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.