Oncological Emergencies Dr. Gary Harding md, frcpc

Most common findings are

• Mediastinal widening
• Pleural effusion

CT Chest

• Preferred choice

• IV contrast

• defines the level of obstruction
• Maps out collateral pathways
• Can identify underlying cause of obstruction

Venography

• Bilateral upper arm venograpy

• superior to CT to define site of obstruction
• Does not define cause unless thrombosis is solely responsible

Helical CT

• With bilateral upper arm IV contrast injection

• Best visualization of level of obstruction and cause

MRI

• Can be useful in patients with IV contrast allergies

Histologic Diagnosis

• Essential

• Guides treatment

• Aids in defining prognosis

Histologic Diagnosis

• Sputum cytology, pleural fluid cytology, biopsy of enlarged peripheral nodes

• Bone marrow biopsy for NHL

• Bronchoscopy, mediastinoscopy, or thoracotomy are more invasive but sometimes necessary