The Annals of Thoracic Surgery, Vol 32, 458-462, Copyright © 1981 by The Society of Thoracic Surgeons
Mediastinoscopy in advanced superior vena cava obstruction
RJ Lewis, GE Sisler and JW Mackenzie
Superior vena cava syndrome can be a rapidly progressive, lethal process
that is caused by a malignancy in 92 to 94% of cases. Since all effective
therapy is inherently harmful, it would be reassuring to have a definitive
tissue diagnosis before initiating treatment. Because easily accessible
tissue is not always available, mediastinoscopy must be relied on to
confirm the diagnosis in some patients. Twenty-nine patients with advanced
superior vena cava syndrome were reviewed. Fifteen of them required
mediastinoscopy to confirm the diagnosis, since lesser procedures, i.e.,
bronchoscopy, needle biopsy, and sputum cytology, were negative for
malignant tissue. Contrary to reports in the literature, mediastinoscopy
can be performed safely in patients with advanced superior vena cava
syndrome and can yield a definitive diagnosis in each.