Young female dyspnea on exertion is progressively worsening, what is the most suitable treatment for this patient?

In yesterday's [Weekly Medical Questions] column, we pushed the latest issue of NEJM Knowledge+ Question of the Week
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[Weekly Medical Questions] Young women's dyspnea on exertion is progressively worsening.
What is the most suitable treatment for this patient? Today, we announce the answer
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Did you see the answer? Of course, answering right is not the goal, mastering the key points and expanding knowledge is the kingly way
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Answer: Mediastinal mass biopsy Learning points: For hemodynamically stable mediastinal mass patients with symptoms of superior vena cava syndrome, the initial treatment is biopsy to confirm the diagnosis
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EXPANDED KNOWLEDGE This patient had an isolated large mediastinal mass, elevated lactate dehydrogenase levels, and type B symptoms (fever, unintended weight loss, and night sweats)
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This presentation is typical of primary mediastinal large B-cell lymphoma
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It is critical to obtain an accurate histological diagnosis before treatment begins, or even before initiation of glucocorticoids, as glucocorticoids can adversely affect the accuracy of pathological diagnosis, or delay confirmation
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Although this patient had superior vena cava compression, there were no signs of thrombosis, so there was no indication for thrombolysis or heparin therapy
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In the absence of severe respiratory dysfunction or neurological changes, endovascular stenting of the superior vena cava or emergency radiotherapy for mediastinal masses does not make sense
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[Weekly Medical Questions] will be continuously updated
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What would you like to see or learn? Please let us know through comments and look forward to your valuable comments and suggestions
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References 1.
Yu JB et al.
Superior vena cava syndrome--a proposed classification system and algorithm for management.
J Thorac Oncol 2008 Aug; 3:811.
2.
Wilson LD et al.
Clinical practice.
Superior vena cava syndrome with malignant N Engl J Med 2007 May 3; 356:1862.
3.
Klein-Weigel PF et al.
Superior vena cava syndrome causes.
Vasa 2020 Oct; 49:437.
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