A Rare Cause of Breathlessness in a Patient on Hemodialysis

• Published in: Journal of the Association of Physicians of India Vol. 70; no. 2; pp. 11 - 12
• Main Authors: Bansal, Varun Gulshan, Khanna, Umesh Balkrishna, Vora, Agam, Shah, Bhavin, Shingada, Aakash
• Format: Journal Article
• Language: English
• Published: India 01.02.2022
• Subjects: Catheterization, Central Venous - adverse effects; Chylothorax - etiology; Chylothorax - therapy; Constriction, Pathologic; Dyspnea - etiology; Female; Humans; Jugular Veins; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - therapy; Male; Pleural Effusion - etiology; Pleural Effusion - therapy; Renal Dialysis - adverse effects; Vena Cava, Superior
• ISSN: 0004-5772

Patients suffering from end stage renal disease (ESRD) often present to the emergency with breathlessness, mostly due to fluid overload. We report a rare case of recurrent unilateral massive pleural effusion in an ESRD patient on maintenance hemodialysis (MHD). The patient was on MHD thrice weekly for the last 2 years with right internal jugular vein (IJV) tunneled cuffed catheter (TCC). Chylothorax was identified as the cause of recurrent pleural effusion which was due to superior vena cava stenosis (SVCO). It was managed successfully by balloon venoplasty of SVC and anticoagulation. SVCO is a rare but a serious complication in patients on long term indwelling dialysis catheters. Physicians involved in the care of dialysis patients must be aware about complications of long term dialysis catheters like central vein stenosis. A strong suspicion of chylothorax should be reserved for a patient with recurrent unilateral pleural effusion and long term dialysis catheters.