title: Unusual cause of superior vena cava syndrome diagnosed with transesophageal echocardiography.
abstract: OBJECTIVE
  An unusual case of superior vena cava (SVC) syndrome caused by an infected right atrial-SVC junction thrombus may be diagnosed using transesophageal echocardiography.
  
  
  METHODS
  A 59-yr-old male with end-stage renal disease requiring hemodialysis presented with fungemia and later developed facial and bilateral upper extremity edema. Transesophageal echocardiography revealed subtotal occlusion of the SVC at its junction with the right atrium. The mass was surgically removed with cardiopulmonary bypass support. Pathological examination of the mass confirmed the presence of a large fungal colony of Candida species mixed in the thrombus. The patient's signs and symptoms of SVC obstruction resolved, and he was discharged from the hospital four weeks later in stable condition.
  
  
  CONCLUSIONS
  Although usually caused by extrinsic tumour compression, SVC syndrome can result from intravascular caval obstruction. This etiology should also be considered in the differential diagnosis, particularly in patients with intravascular devices. Transesophageal echocardiography is a valuable diagnostic tool in these cases.
authors.affiliation: Department of Anesthesiology, Box 3094, Duke University Medical Center, Durham, NC 27710, USA. barbe030@mc.duke.edu
authors.forename: Atilio
authors.initials: A
authors.lastname: Barbeito
authors.forename: Shahar
authors.initials: S
authors.lastname: Bar-Yosef
authors.forename: James E
authors.initials: JE
authors.lastname: Lowe
authors.forename: Broadus Z
authors.initials: BZ
authors.lastname: Atkins
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Mark
mesh_terms: D002177:Candidiasis / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D002315:Cardiopulmonary Bypass; D017548:Echocardiography, Transesophageal; D004487:Edema / Q000209:etiology / Q000601:surgery; D016469:Fungemia / Q000150:complications* / Q000382:microbiology / Q000601:surgery; D006325:Heart Atria / Q000382:microbiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D013479:Superior Vena Cava Syndrome / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000601:surgery; D013927:Thrombosis / Q000150:complications* / Q000382:microbiology / Q000601:surgery