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A 47-year-old man was referred to our hospital because of dyspnea, cough and weight loss. On physical examination, marked dilatation of thoraco-superficial epigastric venous anastomosis was found. The chest wall collateral vessels revealed enlarged head-to-toe flow, suggesting complete obstruction of the SVC and one or more of the major caval tributaries, including the azygos system. Thoracic CT demonstrated that a huge anterior mediastinal tumor completely obstructed the superior vena cava. He was diagnosed with Hodgkin lymphoma of the nodular sclerosis type, Stage III(X)B based on the biopsy specimen from the right subcutaneous lumbodorsal mass.

Superior vena cava (SVC) syndrome is usually caused by malignant tumors or their lymph node metastases oppressing a SVC. However, we encountered a case of SVC syndrome that was caused by a thrombus in the SVC, which we considered as a manifestation of Trousseau's syndrome triggered by underlying prostate cancer. A 60-year-old man patient complained of facial swelling. Physical examinations suggested SVC syndrome; enhanced CT and MRI demonstrated the presence of thrombus in the SVC accompanied by multiple mediastinal and axillary lymph node swelling. Histological examination of both percutaneous transluminally aspirated thrombus via a catheter through jugular vein and the axillary lymph nodes included metastatic prostate cancer. Although the ultrasonic and MR images were not compatible with the prostate cancer, needle biopsies from the prostate established the diagnosis. The SVC syndrome as an initial manifestation of underlying unknown malignancy and also due to intravascular thrombosis caused by cancer metastasis to the vascular wall is extremely uncommon.

A 72-year-old man presenting with the superior vena cava syndrome and intracardiac mass was admitted to our hospital. The mass was resected and confirmed to be invasive thymoma. Three years later, he was re-admitted with recurrence into the intracardiac space without any changes in the anterior mediastinum mass. The mass occupied the right atrial cavity and protruded into the right ventricle, causing right ventricular inflow tract obstruction. He underwent re-operation and irradiation. His postoperative course was uneventful, and he has remained alive. Invasive thymoma with intracardiac extension is extremely rare.

We encountered a patient with Graves' disease showing superior vena cava (SVC) syndrome. The patient was a 72-year-old woman with diffuse nontoxic goiter (diagnosed as chronic thyroiditis); she developed Graves' disease during L-T4 administration. Radioiodine-131 therapy failed to give sufficient effect, and the intrathoracic goiter became enlarged in association with increases in thyroid stimulating antibody activities, followed by the development of SVC syndrome. The surgically excised thyroid gland was diffuse without any nodules. Microscopic findings revealed adenomatous hyperplasia. The present case, though extremely rare, seems important for the understanding of the mechanism of onset of SVC syndrome in relation to thyroid gland enlargement.