Facial flushing can be a rare presentation of SVC syndrome

Facial plethora is a rare presentation of superior vena cava syndrome (SVCS). We report facial plethora and feeling of fullness in the head and neck in a 37-year-old female with cardiomyopathy and implantable cardioverter defibrillator (ICD) placement. She remained undiagnosed for a year despite computed tomogram (CT) imaging. Based on her symptoms, a diagnosis of SVCS was suspected and confirmed with diagnostic venogram. Symptoms resolved transiently with initial venoplasty. She presented with recurrent incapacitating symptoms in a year. This required repeat venoplasty, lead extraction and placement of subcutaneous ICD. She remains asymptomatic a year after this procedure.