Central venous catheter selection in mediastinal tumors: An integrated clinical, ultrasound, and CT-based approach.

The mediastinum contains critical components of the central venous axis, including the superior vena cava (SVC) and brachiocephalic veins (BCVs). Mediastinal tumors, although rare, may cause extrinsic compression or invasion of these vessels, significantly affecting the safety and feasibility of central vascular access device (CVAD)1 placement. Approximately 20%-40% of mediastinal masses cause clinically or radiologically significant compression of mediastinal vessels. This rate increases to 30%-50% in malignant tumors and exceeds 50% in mediastinal lymphomas. The anterior mediastinum represents the compartment at highest risk for vascular compression. Superior vena cava syndrome (SVCS) occurs in approximately 5% of all mediastinal tumors and is predominantly of oncologic origin. Pre-procedural assessment using ultrasound-based protocols and contrast-enhanced chest computed tomography (CT) is essential to guide safe CVAD placement. In the presence of significant central venous compression or invasion, avoidance of the upper venous district and consideration of alternative access routes are recommended.