Superior Vena Cava Thrombosis Due to a Temporary Hemodialysis Catheter Presenting After 5 Years With Hematemesis, Hemoptysis and Pleural Effusion

Abstract

Superior vena cava (SVC) thrombosis is increasingly seen now due to the liberal use of intravascular catheters. Most of these cases present with symptoms acutely, like any case of deep vein thrombosis, usually with ipsilateral arm and face swelling. Our patient presented after 5 years with unusual symptoms that are unrelated to the thrombosis itself, but due to the collateral circulation. He was a 38-year-old male patient with end-stage renal disease on hemodialysis (HD) for 9 years, initially via a left arm arteriovenous (AV) fistula, then via a temporary right subclavian dialysis catheter for a period of 5 months before being maintained on his current AV fistula in the right arm for the last 5 years. He presented with intermittent episodes of hematemesis and hemoptysis, and was also found to have pleural effusion. He was found to have chronic thrombosis in the SVC. Chronic SVC obstruction causes formation and increase in the flow in the collateral circulation in the esophageal plexus causing varices, in the intercostals veins causing pleural fluid formation, and in the bronchial veins leading to hemoptysis. The AV fistula aggravated these findings by further increasing the flow and the pressure in the collateral circulation. In conclusion, chronic SVC thrombosis can occur as a consequence of HD catheters, and may present with symptoms related to the collateral circulation.




J Med Cases. 2014;5(10):515-518
doi: http://dx.doi.org/10.14740/jmc1925w