Am. J. Respir. Crit. Care Med., Vol 149, No. 3, 03 1994, 783-787.
Superior vena cava syndrome. Rapid histologic diagnosis by ultrasound- guided transthoracic needle aspiration biopsy
JC Ko, PC Yang, A Yuan, DB Chang, CJ Yu, HD Wu, LN Lee, SH Kuo and KT Luh
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Republic of China.
We prospectively analyzed the diagnostic yield and safety of ultrasound
(US)-guided transthoracic needle aspiration biopsy in the histologic
diagnosis of 40 patients with superior vena cava (SVC) syndrome. During a
4-yr period, 40 patients with SVC obstruction were admitted to National
Taiwan University Hospital. Of these patients 10 had histologic
confirmation by sputum cytology (3 patients), fiberoptic bronchoscopy with
biopsy (2 patients), or lymph node biopsy (5 patients) at admission. A
total of 30 undiagnosed patients underwent real-time ultrasonographic (US)
evaluation as well as color Doppler imaging. Patients with tumor detectable
by US underwent US-guided transthoracic needle aspiration biopsy. Of the 30
patients who received US chest examination, 29 had widening of the upper
mediastinal shadows in the chest radiographs. In 27 patients tumors were
detected by chest US. After assessment of collateral vessels by color
Doppler US, these 27 patients underwent US-guided transthoracic needle
aspiration biopsies; histologic diagnoses were confirmed in 25. The
diagnostic yield was 83.3%. The mean duration from admission to histologic
diagnosis was 2.1 days. None of the patients developed complications. We
conclude that chest US and color Doppler images are useful tools for
evaluation of patients with SVC syndrome. US-guided transthoracic needle
aspiration biopsy appears to be a safe, effective, and rapid approach for
obtaining an accurate histologic diagnosis. Specific treatment can thus be
initiated without delay.
