The mediastinum contains critical components of the central venous axis, including the superior vena cava (SVC) and brachiocephalic veins (BCVs). Mediastinal tumors, although rare, may cause extrinsic compression or invasion of these vessels, significantly affecting the safety and feasibility of central vascular access device (CVAD)1 placement. Approximately 20%–40% of mediastinal masses cause clinically or radiologically significant compression of mediastinal vessels. This rate increases to 30%–50% in malignant tumors and exceeds 50% in mediastinal lymphomas. The anterior mediastinum represents the compartment at highest risk for vascular compression. Superior vena cava syndrome (SVCS) occurs in approximately 5% of all mediastinal tumors and is predominantly of oncologic origin. Pre-procedural assessment using ultrasound-based protocols and contrast-enhanced chest computed tomography (CT) is essential to guide safe CVAD placement. In the presence of significant central venous compression or invasion, avoidance of the upper venous district and consideration of alternative access routes are recommended.
van RensMRvan der LeeRSpencerTR, et al. The NAVIGATE project: a GloVANet–WoCoVA position statement on the nomenclature for vascular access devices. J Vasc Access2025; 26(5): 1439–1446.
2.
ArtetASantiago-PachecoVVilladaJC.Primary mediastinal tumors in children and adults: a clinicopathological spectrum. Mediastinum2025; 9: 1.
3.
WhooleyBPUrshelJDAntkowiakJD.Primary tumors of the mediastinum. J Surg Oncol1999; 70: 95–99.
4.
YangMZHouXLiangR-B.The incidence and distribution of mediastinal lymph node metastasis and its impact on survival in patients with non-small-cell lung cancers 3 cm or less: data from 2292 case. Eur J Cardiothorac Surg2019; 56(1): 159–166.
5.
YamashitaTWatahikiMAsaiK.Mediastinal metastasis of breast cancer mimicking a primary mediastinal tumor. Am J Case Rep2020; 21: Article e925275.
6.
LjungbergBAlbigesLAbu-GhanemY, et al. European Association of Urology guidelines on renal cell carcinoma. Eur Urol2019; 75(5): 799–810.
7.
MatsudaSTakeuchiMKawakuboH, et al. Lymph node metastatic patterns and the development of multidisciplinary treatment for esophageal cancer. Dis Esophagus2023; 36(4): Article doad006.
8.
RiihimäkiMHemminkiASundquistK, et al. Metastatic spread in patients with gastric cancer. Oncotarget2016; 7(32): 52307–52316.
9.
RiihimäkiMHemminkiASundquistJ, et al. Patterns of metastasis in colon and rectal cancer. Sci Rep2016; 6: Article 29765.
10.
LeónXQuerMOrúsC, et al. Distant metastases in head and neck cancer patients who achieved loco-regional control. Head Neck2000; 22(7): 680–686.
11.
CarterBWBenvenisteMFMadanR, et al. ITMIG classification of mediastinal compartments and multimodality imaging of mediastinal masses. Radiographics2017; 37(2): 413–436.
12.
RiceTWRodriguezRMLightRW.The superior vena cava syndrome: clinical characteristics and evolving etiology. Medicine2006; 85(1): 37–42.
13.
WilsonLDDetterbeckFCYahalomJ.Clinical practice. Superior vena cava syndrome with malignant causes. N Engl J Med2007; 356(18): 1862–1869.
14.
LiWWLvan BovenWJPAnnemaJT, et al. Management of large mediastinal masses: surgical and anesthesiological considerations. J Thorac Dis2016; 8(3): E175–E184.
15.
SavageKJ.Primary mediastinal large B-cell lymphoma. Blood2022; 140(9): 955–970.
16.
AnsellSM.Hodgkin lymphoma: diagnosis and treatment. Mayo Clin Proc2015; 90(11): 1574–1583.
BokemeyerCNicholsCRDrozJP, et al. Extragonadal germ cell tumors of the mediastinum and retroperitoneum: results from an international analysis. J Clin Oncol2002; 20(7): 1864–1867.
19.
DetterbeckFCParsonsAM.Management of stage I and II thymoma. Thorac Surg Clin2011; 21(1): 59–67.
20.
KuriyamaSImaiKIshiyamaK, et al. Using CT to evaluate mediastinal great vein invasion by thymic epithelial tumors: measurement of the interface between the tumor and neighboring structures. Eur Radiol2022; 32(3): 1891–1901.
21.
JiangMLiWHeY, et al. Aetiologic diagnosis of thoracic granulomatous diseases: a retrospective multicentre study in South–Central China. BMJ Open2025; 15(11): Article e102521.
22.
DavisRDOldhamHNSabistonDC.Primary cysts and tumors of the mediastinum: recent changes in clinical presentation, methods of diagnosis, management, and result. Ann Thorac Surg1987; 44: 229–237.
23.
LepperPMOttSRHoppeH, et al. Superior vena cava syndrome in thoracic malignancies. Respir Care2011; 56(5): 653–666.
24.
GorskiLA.Update: the 2024 infusion therapy standards of practice. Home Healthc Now2024; 42(4): 198–205.
25.
BresciaFPittirutiMSpencerTR, et al. The SIP protocol update: eight strategies, incorporating Rapid Peripheral Vein Assessment (RaPeVA), to minimize complications associated with peripherally inserted central catheter insertion. J Vasc Access2024; 25(1): 5–13.
26.
BresciaFAnnettaMGPinelliF, et al. A GAVeCeLT bundle for PICC-port insertion: the SIP-Port protocol. J Vasc Access2024; 25(6): 1713–1720.
27.
SpencerTRPittirutiM.Rapid Central Vein Assessment (RaCeVA): a systematic, standardized approach for ultrasound assessment before central venous catheterization. J Vasc Access2019; 20(3): 239–249.
28.
AnnettaMGElliSMarcheB, et al. Femoral venous access: state of the art and future perspectives. J Vasc Access2025; 26(2): 361–371.
29.
BresciaFPittirutiMOstroffM, et al. The SIF protocol: a seven-step strategy to minimize complications potentially related to the insertion of femorally inserted central catheters. J Vasc Access2023; 24(4): 527–534.
30.
AnnettaMGMarcheBDolcettiL, et al. Ultrasound-guided cannulation of the superficial femoral vein for central venous access. J Vasc Access2022; 23(4): 598–605.
31.
AnnettaMGMarcheBOrtiz MiluyG, et al. Totally implanted central venous access devices inserted by the femoral route: a narrative review and the proposal of a novel approach, the FICC-port. J Vasc Access2025; 26(3): 871–879.
32.
AnnettaMGMarcheBGiarrettaI, et al. Applicability and feasibility of intraprocedural tip location of femorally inserted central catheters by transhepatic ultrasound visualization of the inferior vena cava in adult patients. J Vasc Access2024; 25(2): 651–657.
33.
AnnettaMGElliSGidaroA, et al. Ultrasound-based tip navigation and tip location during placement of central venous access devices in adult patients: the ECHOTIP protocol revisited. J Vasc Access2025; 27(2): 409–415.
34.
FaraoneVPittirutiMAnnettaMG, et al. An Italian expert consensus on the choice of the method of tip location for central venous access devices. J Vasc Access2025; 27(1): 12–25.
35.
BenvenutiSPiervincenziEAnnettaMG, et al. Lumbar vein malposition of femorally inserted central venous catheters: report of three cases and review of the literature. J Vasc Access2026; 2026: Article 11297298261421383.
