MEDIASTINOSCOPY IN ADVANCED SUPERIOR VENA-CAVA SYNDROME

Cervical mediastinoscopy is a method to evaluate mediastinal masses an d staging bronchogenic carcinoma. Despite its widespread use, contrain dications concerning vascular compression syndromes have not been well established There is a fear based on the risk of hemorrhagic complica tions but hopefully morbidity is not as expected. Since 1986, mediasti noscopy was performed on 22 patients presenting caracteristic signs of Superior Vena Cava obstruction. C.T. confirmed obstruction of SVC in all cases and cavograms showed colateral circulation in 8. The histolo gic findings were lymphomas (6), germ-cell tumors (2), squamous cell l ung carcinoma (3), large cell (2), and oat-cell (5). Benign lesions (i nespecific adenitis and mediastinal fibrosis) were diagnosed in 4 case s. One hemorrhagic complication occurred due to a lesion of the vena c ava (hemostasys was reached by local compression and biological glue). Venous congestion seems to apply only to superficial tissues and allo ws mediastinoscopy to be a useful and reliable procedure.