Mediastinoscopy in SVC obstruction

 

Diagnostic algorithm for acute superior vena caval obstruction (SVCO);The Journal of Cardiovascular surgery 1993;34:347-350.

Patients at low risk can be expected to tolerate mediastinoscopy with low risk - approaching that of the normal cancer population. The high risk relates to the likelihood of catastrophic bleeding or cardio-respiratory compromise. Where possible other forms of diagnosis should be used. If mediastinoscopy is required SVC stenting or even sapheno-jugulo bypass under local anaesthetic should be considered.

Low risk

  1. •Longer history

  2. •Not dyspnoeic at rest

  3. •No facial cyanosis

  4. •Asked to lie flat-no change in cyanosis or SOB


High risk

  1. •Facial cyanosis

  2. •Dyspnoea sitting

  3. •Develop symptoms supine