Mediastinal Tumors: The Role of Cardiac Magnetic Resonance in a Case of Superior Vena Cava Syndrome.

Presenting Author(s)

• 

  Camilla F. Reimberg, MD

  Doctor
  Instituto Dante Pazzanese de Cardiologia
  São Paulo , Sao Paulo, Brazil

Primary Author(s)

• 

  Camilla F. Reimberg, MD

  Doctor
  Instituto Dante Pazzanese de Cardiologia
  São Paulo , Sao Paulo, Brazil

Co-Author(s)

• GM

  Gustavo R. Modolo, MD

  Doctor
  Instituto Dante Pazzanese de Cardiologia, Brazil
• 

  Marina R. Cavallari, MD

  Doctor
  Instituto Dante Pazzanese de Cardiologia
  São Paulo, Sao Paulo, Brazil
• 

  Natassia SSC Gomes, MD

  Doctor
  Instituto Dante Pazzanese de Cardiologia
  São Paulo, Sao Paulo, Brazil
• EB

  Everton R. Barbosa, MD

  MD
  Instituto Dante Pazzanese de Cardiologia, Brazil
• RH

  Rafael Hendges, MD

  Doctor
  Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
• JC

  João Marcelo Caneschi, MD

  Cardiologist
  Instituto Dante Pazzanese de Cardiologia
  São Paulo, Sao Paulo, Brazil
• 

  Alice Cunha Darzé, MD

  Cardiologist
  Instituto Dante Pazzanese de Cardiologia
  São Paulo, Sao Paulo, Brazil
• 

  Amanda Marsiaj Rassi, MD

  Cardiologist
  Instituto Dante Pazzanese de cardiologia
  São Paulo, Sao Paulo, Brazil
• LP

  Luciano G. Possa, MD

  Doctor
  Instituto Dante Pazzanese de Cardiologia, Brazil
• 

  Paul Salvador Salvador Morales, MD

  Cardiologist
  Instituto Dante Pazzanese de Cardiologia
  São Paulo, Sao Paulo, Brazil
• CP

  Carlos Eduardo E E D Prazeres, MD

  Doctor
  Instituto Dante Pazzanese de Cardiologia, Brazil
• 

  Antonio Tito 3. Paladino Filho, MD, PhD

  Cardiologist
  Hospital Vila Nova Star, Rede D’or São Paulo-SP
  Sao Paulo, Sao Paulo, Brazil
• 

  Tiago Senra, MD, PhD

  Physician
  Dante Pazzanese Institute of Cardiology
  Sao Paulo, Sao Paulo, Brazil
• 

  Ibraim Masciarelli Pinto, MD, PhD

  Director, Non Invasive Cardiology
  Instituto Dante Pazzanese de Cardiologia
  Sao Paulo, Sao Paulo, Brazil

Description of Clinical Presentation: Mediastinal tumors represent a heterogeneous group of neoplasms, accounting for approximately 3% of thoracic malignancies. Their clinical presentation is variable and often nonspecific, including compressive symptoms on mediastinal structures such as airways, vessels, and cardiac chambers. One of the most severe complications is superior vena cava syndrome (SVCS), occurring in about 10% of patients with mediastinal masses, particularly in malignant tumors. Cardiac magnetic resonance (CMR) plays a fundamental role in the differential diagnosis, assessment of local extension, and therapeutic planning, providing highly accurate anatomical and functional information.
A 66-year-old male patient was admitted with lower limb edema, progressive dyspnea, and paroxysmal nocturnal dyspnea for two months. Diagnostic investigation revealed a large mediastinal mass associated with signs of ventricular restriction.
The patient was diagnosed with Superior Vena Cava Syndrome secondary to the mediastinal mass and was referred for biopsy at an external facility, which confirmed malignancy. He is currently undergoing chemotherapy

Diagnostic Techniques and Their Most Important Findings: Patient underwent to a 3 Tesla Magnetic Field, the study protocol was based on single shot cines in two, three and four chambers as well as short axis aquisitition, triple pulse to evaluate edema, double pulse to evaluate fatty infiltration, delayed enhancement after the administration of gadolinium contrast.
CMR demonstrated a small pericardial effusion and sparse myocardial edema in the lateral wall, without fatty infiltration. An extracardiac mass measuring 11.9 × 7.6 cm was identified, invading both atria and in close contact with the ascending aorta, left coronary artery trunk, right pulmonary artery, pulmonary veins, superior vena cava, distal trachea, and right main bronchus.

Learning Points from this Case: This case highlights the relevance of CMR in the characterization of mediastinal tumors, allowing comprehensive evaluation of tumor extension and its relationship with vital thoracic structures. The method proved essential for both diagnosis and therapeutic planning, guiding clinical management in a patient with superior vena cava syndrome. The integration between advanced cardiovascular imaging and a multidisciplinary oncological approach is emphasized in the management of complex cases.

Coronal evidencing the mass extension to superior vena cava.
Short axis evidencing the mass invasion.
Four Chamber showing the mass projection to vital structures