Complete occlusion of the superior vena cava with chronic mediastinitis in a case of generalized actinomycosis.

Ochsner and Dixon (1936), in a review of world literature, cited 120 cases of supenor vena caval thrombosis. Twenty-eight of these were due to chronic mediastinitis, of which eleven were stated to be due to syphilis, ten to tuberculosis, one to pyogenic infection, one to trauma, and five of unknown aetiology. Tubbs (1946) reported three further cases of superior vena caval obstruction, one of which was probably due to syphilis, the remaining two being of unknown aetiology. Renbourn (1946) reported a case of superior vena caval thrombosis of unknown aetiology, with complete superior vena caval obstruction. The above authorities do not mention actinomycosis as a cause. Cope (1938) stated that " primary thoracic actinomycosis can and most likely does fairly frequently commence by the fungus penetrating the wall of the oesophagus and reaching the mediastinum." He described two main types, the pulmonary and the mediastinal, and he discussed the general symptoms and signs of thoracic actinomycosis and its complications, but did not mention superior vena caval obstruction among these. Fischer (1904) gave actinomycosis as the cause of superior vena caval obstruction in 0.5 per cent of cases, but I was unable to trace a copy of this work. Nor was I able to find, in the literature available, any other reported cases of superior vena caval occlusion with chronic mediastinitis due to actinomycosis.