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