Hemodialysis catheter-associated superior vena cava syndrome and pulmonary embolism: a case report and review of the literatureReportar como inadecuado




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BMC Research Notes

, 9:233

Pulmonary Medicine

Abstract

BackgroundHemodialysis HD catheters are frequently inserted into the superior vena cava SVC, and can lead to thrombotic complications. However, to our knowledge, HD catheter-related thrombosis leading to subsequent SVC syndrome, bacteremia, and pulmonary emboli has not been described.

Case presentationA 28-year-old dialysis-dependent woman with IgA nephropathy developed facial swelling, head pressure, headache, nausea, dizziness and fever 6 weeks after right internal jugular IJ HD catheter placement. Chest and neck imaging demonstrated a non-occlusive thrombus surrounding the HD catheter and extending from the SVC to the junction of the right IJ and right subclavian veins, confirming thrombosis-associated SVC syndrome. Intravenous IV anticoagulation was initiated, as well as IV vancomycin for Staphylococcus epidermidis bacteremia. Despite prompt intravenous anticoagulation, 9 and 12 days after initial presentation she developed catheter-associated pulmonary embolism PE and PE-associated pulmonary infarction, respectively. Hypercoagulable workup was negative. The HD catheter was eventually replaced, HD resumed, and the patient was transitioned from intravenous to oral anticoagulation and discharged. Nine months later, she underwent successful renal transplantation.

ConclusionSVC syndrome and pulmonary embolism are potential consequences of HD catheter-related thrombosis. Given the frequency of HD catheter placement, physicians should be aware of these potential complications in any patient with HD catheter-related thrombosis.

KeywordsHemodialysis Catheter Thrombosis Superior vena cava syndrome Pulmonary embolism AbbreviationsHDhemodialysis

SVCsuperior vena cava

IJinternal jugular

IVintravenous

PEpulmonary embolism

CVCcentral venous catheter

ESRDend-stage renal disease

CTcomputed tomography

CTAcomputed tomography angiography

INRinternational normalized ratio

PTprothrombin time

DVTdeep venous thrombus

DSAdigital subtraction angiography

MNmembranous nephropathy

FSGSfocal segmental glomerulosclerosis

RCTrandomized controlled trial

ACCPAmerican College of Chest Physicians

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Autor: Sritika Thapa - Peter B. Terry - Biren B. Kamdar

Fuente: https://link.springer.com/







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