Superior vena cava syndrome: experience in a teaching hospital

Between 1972 and 1985, 39 patients with superior vena cava syndrome were admitted to the Medical College of Georgia Hospitals. I have reviewed the hospital courses of these patients and compared clinical and laboratory findings with those reported in previous series. The syndrome was malignant in 34 patients (mean age of 50 years) and benign in five (mean age of 30 years). Duration of symptoms before diagnosis was 17 months in patients with benign disease and 18 days in those with malignant disease. Presence of symptoms for less than four weeks was associated with a high likelihood of malignancy. Invasive diagnostic procedures established a diagnosis in 33 patients, and no procedural complications occurred. Computerized tomography (CT) of the chest confirmed superior vena cava obstruction and localized the level of obstruction in all six patients in whom it was done. Information gained from venacavograms did not alter therapeutic decisions. In eight patients, establishment of a definitive histologic diagnosis altered the treatment. Treatment relieved the symptoms in 69% of the patients with malignant superior vena cava syndrome, and no patient had recurrent symptoms after therapy.