ACUTE SUPERIOR VENA-CAVAL SYNDROME WITH AIRWAY-OBSTRUCTION FOLLOWING ELECTIVE MEDIASTINOSCOPY

A 47-year-old female patient had a subclinical superior vena caval syn drome which developed into the 'full blown' acute condition when she w as placed into the left lateral position after mediastinoscopy. She de veloped airway obstruction requiring urgent re-intubation and subseque nt admission to the intensive care unit. This subclinical condition mi ght have been suspected pre-operatively if closer attention had been p aid to the history, physical examination and review of the computerise d axial tomography scan: she had a history of intermittent dyspnoea, w heeze and cough which was worse on waking and improved as the day prog ressed, she had a positive Pemberton's sign and the computerised axial tomography scan showed that the lesion was encroaching on the superio r vena cava.