Superior vena cava syndrome is characterised by dyspnoea, headache, facial oedema, and venous distention in the neck, upper chest and arms. These symptoms are bilateral. A 47-year-old woman reported the appearance of venous ectasias in the right side of her chest, face and neck. The patient was affected by systemic lupus erythematous with antiphospholipid syndrome and end-stage renal disease. She was on haemodialysis via a right subclavian central venous silicone, double-lumen, tunnelled catheter (central venous catheter, CVC) because of a previous thrombosis of arteriovenous fistula. Although this type of CVC has a higher risk of complications (ie, thrombosis), the reason of this choice was not clear, since the patient was treated at another haemodialysis service. At physical examination, the patient's clinical condition was discrete; right side of the face appeared slightly swollen; distension of the right external jugular vein and superficial ectasic veins of the right hemithorax were present (figure 1). Ultrasound scan showed a fibrotic right internal jugular vein, without Doppler signal. Neck and chest CT confirmed the lack of contrast enhancement of the right internal jugular vein in its distal tract (5.5 cm) until the confluence with the subclavian vein (figures 2A, B) and the presence of multiple ectasic veins of the subcutaneous tissue of the right anterior chest wall and neck (figures 3 and 4). The CVC was passing through the brachiocephalic vein to the right atrium.
|Rivista||BMJ CASE REPORT|
|Stato di pubblicazione||Pubblicato - 2014|