Adolescent with facial swelling

Background A previously well 15-year-old girl presented with a 2-month history of facial swelling that progressively worsened to involve the neck. There was associated dyspnoea, orthopnoea, headache and throat discomfort. Two weeks before presentation, the patient had an episode of fever for 5 days. On examination, vital signs were within normal limits. Swelling, plethora and venous distension of the face and neck were apparent (figure 1). Questions What is the most likely diagnosis? Superior vena cava syndrome Angioedema Anasarca Diphtheria Describe the chest X-ray (figure 2). What are the acute concerns? What investigations would you order? Answers can be found on page 02.