Neoplastic superior vena caval obstruction: diagnosis with percutaneous needle aspiration.

Obstruction of the superior vena cava arises from a spectrum of etiologies that include both benign and malignant conditions. Therefore, management of this serious disorder varies and depends on the underlying cause. Pursuit of a histologic diagnosis with invasive procedures has been associated with a wide range of diagnostic yields and complications. Percutaneous fine-needle aspiration biopsy has been shown to be highly reliable and well tolerated in the diagnosis of a variety of mediastinal and lung masses. Three patients are presented with obstruction of the superior vena cava in whom computed tomography safely guided percutaneous needle biopsy in obtaining a correct histologic diagnosis. It appears that transthoracic percutaneous needle aspiration biopsy is safe and efficacious in patients with superior vena cava syndrome, but further experience with this increasingly available procedure is warranted.