Superior vena cava syndrome: diagnostic procedures

The hospital records of patients discharged from Presbyterian-University Hospital of Pittsburgh with the diagnosis of superior vena cava syndrome (SVCS) were reviewed in order to determine if diagnostic procedures were associated with an unacceptable risk of complications. Fifty-six cases were reviewed. Symptoms had been present for an average of five weeks. Forty-five patients underwent diagnostic tests including sputum cytology, lymph node biopsy, bone marrow biopsy, bronchoscopy, mediastinoscopy and thoracotomy. The diagnostic yield of these procedures ranged from 28% (cytology) to 100% (thoracotomy). Complications occurred only with mediastinoscopy and none of these were fatal or caused long-term morbidity. We conclude that most patients with SVCS (excepting those with neurologic or respiratory compromise) can tolerate a vigorous pursuit of a histologic diagnosis before therapy is instituted.