Endobronchial Ultrasound Diagnosis of a Malignant Superior Vena Cava Tumor Thrombus Extending Into the Right Atrium: An Unusual Cause of Recurrent Syncope

Figure 1. An intraluminal tumor thrombus (red triangle) within the SVC diagnosed by Endobronchial Ultrasound with Trans-bronchial Needle Aspiration (EBUS-TBNA). The patent lumen, posterior to the SVC, is the aorta. SVC- superior vena cava;

Figure 2. The left image is central venography from bilateral axillary vein injections demonstrating severe SVC stenosis due to a known tumor. The yellow diamond shape is placed where the SVC should be located. However, the Azygous vein (RED arrow) is noted to be more prominent. The right image was taken after percutaneous balloon angioplasty and stent placement which showed significant flow through the SVC without residual stenosis, as seen with the BLACK arrow. Also, note that the Azygous vein is not as prominent with relief of SVC obstruction.

Figure 3. Tumor cells exhibit marked pleomorphism with prominent nucleoli, coarse chromatin, and cellular dyscohesion (Cell block A). The cytoplasm is delicate and foamy as demonstrated by the Yellow arrow), favoring adenocarcinoma over squamous cell carcinoma (Cell block B). Immunohistochemical IHC C analysis revealed a positive nuclear reaction for TTF-1, consistent with pulmonary adenocarcinoma. Thyroid transcription factor 1 (TTF-1) is commonly overexpressed in adenocarcinoma versus non-adenocarcinoma lung tumors.