Anatomy clinical correlates Quiz: Ace Your Exams

A 62-year-old man presents to the emergency department for evaluation of facial swelling. Over the past several weeks, he has noticed his face has become “puffier,” particularly in the morning. In addition, he has a new cough and shortness of breath on exertion. His own past medical history is unremarkable, though his father passed away from a pulmonary embolism. The patient takes no medications. He has smoked one pack of cigarettes per day for thirty years. He does not use alcohol or illicit drugs. Temperature is 37.6°C (99.7°F), pulse is 111 /min, and blood pressure is 131/66 mmHg. Respirations are 18/min, and oxygen saturation is 96% on room air. Physical examination demonstrates distended neck veins and bilateral facial fullness without tenderness to palpation or erythema. Which of the following is the most likely etiology of this patient's clinical presentation?