Superior Vena Caval Canal Obstruction

Abstract

(1) Sixty-one patients with superior vena caval obstruction are reviewed, of which six are secondary to benign disease. (2) Diagnosis is usually made by bronchoscopic examination or clinical evaluation. Supraclavicular or mediastinal node biopsy, and anterior thoracotomy are only employed in selected cases, because of the increased risk of hemorrhage. (3) Current preferred therapy for malignant lesions employes the initial use of chlorothiazide (Diuril) and intravenous nitrogen mustard followed by irradiation therapy. (4) In malignant lesions, the direct surgical attack to palliate the symptoms of superior vena caval obstruction is not as effective as conservative therapy and produces a higher morbidity, mortality and failure rate. The prognosis depends on the underlying disease. (5) Surgical resection has failed to extend survival in malignant cases and is not as effective as radiation alone. (6) An unusual case of a large cell undifferentiated carcinoma of the lung presenting superior vena caval obstruction with metastases to the cervical lymph nodes had survived six years following nitrogen mustard and irradiation therapy. (7) A patient with mediastinal Hodgkin's disease is alive with a patent Teflon graft between the superior vena cava and right atrium which was constructed five years ago for superior vena caval obstruction.