This retrospective review was performed with an intent to clarify several misconceptions associated with superior vena cava syndrome (SVCS). During a 16-yr period, we diagnosed and treated 63 patients with SVCS, including seven (11%) children younger than 10 yr of age. Thirty patients (47.6%) had bronchogenic carcinoma, and 13 (20.6%) had lymphoma. In 43 cases SVCS was the presenting symptom of a mediastinal condition. Forty-one patients underwent diagnostic procedures with no major complications, and diagnosis was obtained in 36. Only six patients had surgical treatment, and 45 had radiation therapy, chemotherapy, or both. There was no mortality associated directly with venous congestion. Symptomatic relief occurred in 80% of treated patients. We conclude that: (1) SVCS per se should not be feared (symptomatic relief is the rule), (2) accurate diagnosis can be achieved with minimal morbidity, and (3) the versatile underlying etiology dictates the outcome that can be improved with appropriate therapy.