Odynophagia in sickle cell anemia: Pain is not always a crisis

This report describes the case of a 30-year-old African American male with sickle cell anemia who presented with odynophagia and chest pain. Clinical examination revealed tachypnea, conjunctival congestion, icterus, facial swelling, engorged neck veins, induration over the upper part of chest and arms and a right chest wall port-a-cath. Subsequent imaging revealed occlusion ofboth brachiocephalic veins and proximal superior vena cava with a metallic SVC stent in-situ. Recanalization was attempted but guidewires could not be passed across the site of occlusion. He was then treated with catheter guided t-PA boluses delivered to the site of occlusion and oral anticoagulation.