Intraluminal leiomyosarcoma of the superior vena cava: a cause of superior vena cava syndrome.

Intraluminal tumours of the superior vena cavae (SVC) are extremely rare. We report a 75 year old male who suffered an acute syndrome of the SVC. The CT scan and phlebogram showed thrombosis of the right internal jugular, subclavian and innominate veins and the SVC. Fibrinolysis was started with 250.000 U, of urokinase and maintained for 72 hrs (75.000 U/h). A control phlebogram showed a great filling defect of the SVC which was enhanced in a postcontrast CT scan. An intraluminal leiomyosarcoma was diagnosed. A long and narrow pedunculated tumour was resected through a medial sternotomy and the SVC closed by direct suture without either a patch or a graft. The histopatholoy study confirmed the diagnosis. We cosider this protocol to be the procedure of choice for the diagnosis and treatment of the SVC syndrome since it can demonstrate any intraluminal or extramural aetiology.