Pleural effusion is often a manifestation of the superior vena cava (S
VC) syndrome, However, pleural effusion has never been reported to be
a cause of the SVC syndrome, We report the case of a 68 yr old male pa
tient who presented with SVC syndrome and respiratory failure, both at
tributable to an encapsulated pleural effusion over the right upper me
diastinum. Simple drainage was performed as a diagnostic and therapeut
ic procedure, The pleural effusion was confirmed to be a tuberculous e
mpyema, Chest computed tomography (CT) scan is the most appropriate in
itial diagnostic procedure for superior vena cava syndrome.