ABSTRACT
The symptoms and signs of obstruction of the superior vena cava (SVC) were first described as a clinical entity by J. A. Hunter in 1757 and W. Stokes in 1837. Diagnostic measures are of value in confirming the clinical impression and in obtaining a topographic and etiologic diagnosis of the SVC syndrome. The etiology of SVC syndromes can be intracaval, i.e., thrombotic or parietal, or extra-caval, rarely mediastinitis, tumoral in the vast majority of cases. Superior caval venography remains the most important investigation to confirm the diagnosis and to obtain information about the anatomy and severity of the obstruction. Flexible bronchoscopy can provide a diagnosis if an endobronchial tumor is accessible to biopsy. Histological diagnosis, prerequisite to chemotherapy or irradiation, may be provided by supraclavicular lymph node biopsy in case of clinical involvement. Scintigraphy using technetium seems more suitable to assess the response to irradiation than to compete with classical venacavograms as a diagnostic tool.
