A 59-year-old man who is a heavy smoker presents with cough, shortness of breath, and a sensation of head fullness. Physical examination is notable for cervical venous distention and facial edema. A chest radiograph shows a widened superior mediastinum. What is the most appropriate initial intervention for this patient?

CT of the chest and a venous dye study to rule out thrombosis of the superior vena cava

Initiation of radiation therapy while a diagnostic work-up is pursued

CT of the chest and consultation with a pulmonologist and a thoracic surgeon

A 59-year-old man who is a heavy smoker presents with cough, shortness

1.	A 59-year-old man who is a heavy smoker presents with cough, shortness of breath, and a sensation of head fullness. Physical examination is notable for cervical venous distention and facial edema. A chest radiograph shows a widened superior mediastinum. What is the most appropriate initial intervention for this patient?
A.	Initiation of radiation therapy while a diagnostic work-up is pursued
B.	CT of the chest and consultation with a pulmonologist and a thoracic surgeon
C.	CT of the chest and a venous dye study to rule out thrombosis of the superior vena cava
D.	Mediastinoscopy with biopsy
E.	Ventilation/perfusion scan
Answer» C. CT of the chest and a venous dye study to rule out thrombosis of the superior vena cava

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