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September 25, 1981

Evaluation of Superior Vena Cava Obstruction

JAMA. 1981;246(13):1405. doi:10.1001/jama.1981.03320130015011

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To the Editor.—  The BRIEF REPORT of Shimm et al (1981;245:951) describing their experience with superior vena cava obstruction provides some important information on the invasive evaluation of this syndrome. However, the authors have neglected to include the application of newer imaging modalities such as computed tomography (CT). With the application of second- and third-generation CT scanners, high-resolution images of the neck can be performed after contrast infusion. Thus, neck and chest masses can be more completely evaluated for the site of origin and for possible invasion of venous, arterial or bony structures in these areas. The contrast-enhanced studies will often clearly define obstruction to the superior vena cava or the clot within it. Thus, the full extent of tumor masses can be accurately assessed with this study. While CT cannot predict the cell type of the cancer, it often provides valuable information by defining the site of origin of