Tests
1st tests to order
chest x-ray
Test
Ordered when superior vena cava syndrome is clinically suspected, especially with a history of pulmonary symptoms.
Result
widened mediastinum or mass lesion in the lung
chest CT
Test
Most useful imaging test as it helps to establish diagnosis.[1][2]
Undertaken with intravenous contrast.
Ordered when there is clinical suspicion of superior vena cava syndrome.
Helpful in obtaining a tissue diagnosis by CT-guided biopsy.
Result
full or partial obstruction; development of collateral vessels; shows location, severity, and associated pathology (e.g., malignancy or intravascular thrombosis)
chest MRI
Test
Useful in patients with a history of contrast allergy or those at risk of contrast-induced worsening of renal function.[1][2]
Caution advised in use of gadolinium in renal insufficiency due to risk of nephrogenic fibrosing dermopathy.
Contraindicated in patients with pacemakers and defibrillators.
Result
full or partial obstruction; development of collateral vessels; shows location, severity, and associated pathology (e.g., malignancy or intravascular thrombosis)
ultrasound of upper extremities
Test
Useful noninvasive screening test.
Helps in identification of venous thrombosis or obstruction.[2][19]
Presence of monophasic flow in the superior vena cava (SVC) or loss of respiratory variation on Doppler ultrasound can suggest SVC obstruction.
Result
dilated SVC; presence of thrombus; monophasic flow; loss of respiratory variation
Tests to consider
venography
Test
Invasive test, usually performed by venous catheterization through the femoral vein and injection of contrast dye in the superior vena cava (SVC).
Does not provide information about lung or mediastinal pathology.[1]
Not usually required for diagnosis, but may be useful for planning endoscopic interventions or before surgery.[1][2]
Result
defines site and extent of SVC obstruction and collateral pathways
biopsy
Test
Obtaining tissue diagnosis is important to confirm presence of malignancy.
Bronchoscopy has a diagnostic yield of 50% to 70%, transthoracic needle-aspiration biopsy has a yield of approximately 75%, and mediastinoscopy or mediastinotomy has a diagnostic yield of >90%.[1]
Biopsy from supraclavicular or other cervical lymph node may obviate the need for invasive procedures like mediastinoscopy and, thus, careful examination for cervical lymphadenopathy should be performed.
Result
specimen for pathologic diagnosis
sputum cytology
Test
Simple, noninvasive method to detect lung malignancy. More likely to be positive with central lesions than with peripheral lesions.
Thoracentesis with cytologic analysis should be strongly considered when pleural effusion is present.
Result
malignant cells in sputum
thoracentesis
Test
Thoracentesis involves placing a needle between the ribs and into the chest to sample fluid that has accumulated in the pleural space.
Thoracentesis with cytologic analysis should be strongly considered whenever pleural effusion is present.
Result
malignant cells in pleural fluid
sputum culture
Test
Sputum examination for culture is helpful in diagnosis of cases with tuberculosis, or bacterial or fungal infections (e.g., aspergillosis, blastomycosis, histoplasmosis, nocardiosis).
Result
growth of specific organisms
erythrocyte sedimentation rate
Test
May be present in patients with infection or immunologic disorders.
Result
elevated
C-reactive protein
Test
May be present in patients with infection or immunologic disorders.
Result
elevated
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