The purpose of this paper is, to review the literature in regard to the anatomy, etiology, diagnosis and treatment of the superior vena caval syndrome, and to present 21 cases admitted to the Los Angeles County General Hospital between 1947 and 1954. Superior vena caval obstruction probably dates back to the beginning of disease, but it was not until 1757 that Willian Hunter published the first authentic account of a case which resulted from aontic aneurysm.’ Since then over 500 cases have been reported by various authors, and doubtless hundreds more have been unreported, unrecognized, or were only partial obstructions. The youngest patient recorded was a two month old baby with spontaneous pneumothorax, and the oldest was a 93 year old man with thrombosis of the superior vena cava with extensive collateral circulation.2 Although superior vena caval obstruction has been relatively uncommon in general practice (Hinshaw found four cases in 85,000 consecutive admissions to the White Memorial Hospital in Los Angeles prior to 1947), it is wise to keep this syndrome in mind for its beginnings may be masked by other more obvious conditions. Anatomy: Functionally, the superior mediastinum through which the superior vena cava passes is the busiest transportation route in the body, for through it goes all the air which enters or leaves the lungs, all the food which enters the stomach, all of the lymph which enters the thonacic duct, and all the blood which leaves the heart via the aorta or returns to it via the superior vena cava from the upper half of the body. Anatomically, the superior vena cava is approximately seven centimeters in length extending from the junction of the right and left innominate veins superiorly, to the right auricle inferionly. The azygos vein enters just above the penicardial reflection, and the last two centimeters of the cava lie intrapericardially. The vena cava is one of the most compressible structures in the area, having soft thin walls and a low pressure. It is situated between the rigid bony anterior chest wall anteriorly; the pulsating muscular walled ascending aorta anteromedially; the relatively rigid cartilaginous trachea and right bronchus posteriorly; the soft expandable pleura and right lung laterally; and groups of potentially expanding lymph nodes anteriorly (right anterior mediastinal), posteriorly (right laterotracheal chains), and infero-posteriorly (right bronchial nodes and tracheal bifurcation nodes). In addition it is in close relation to the right pulmonary and innominate arteries, the phrenic nerve which courses over its right lateral surface, and the thyrnus near its anteromedial surface.
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