'Monolateral' superior vena cava syndrome: right internal jugular vein occlusion.
2014
Superior vena cava syndromeis characterised bydyspnoea, headache, facial oedema, and venous dis-tention in the neck,
upper chestand arms. Thesesymptoms are bilateral.A 47-year-old woman reported the appearanceof venous
ectasiasin the right side of her chest,face and neck. The patient was affected by systemiclupus erythematous with antiphospholipid syn-drome and end-stage renal disease. She was onhaemodialysis via a
right subclaviancentral venoussilicone, double-lumen, tunnelled catheter (centralvenous catheter, CVC) because of a previousthrombosis of arteriovenous fistula. Although thistype of CVC has a higher risk of complications (ie,thrombosis), the reason of this choice was notclear, since the patient was treated at anotherhaemodialysis service.At physical examination, the patient’s clinicalcondition was discrete; right side of the faceappeared slightly swollen;
distensionof the rightexternal
jugular veinand superficial ectasic
veinsofthe right hemithorax were present (figure 1).
Ultrasound scanshowed a fibrotic right internaljugular
vein, without Doppler signal. Neck andchest CT confirmed the lack of contrast enhance-ment of the right
internal jugular veinin its distaltract (5.5 cm) until the confluence with the sub-clavian
vein(figures 2A, B) and the presence ofmultiple ectasic
veinsof the subcutaneous tissue ofthe right anterior chest wall and neck (figures 3and 4). The CVC was passing through the brachio-
cephalic veinto the right atrium.These findings were consistent with aCVC-related thrombosis of the internal jugular veinwith a compensatory collateral circulation throughthe external homolateral jugular vein.Figure 1
Distensionof the right external jugular veinand superficial ectasic
veinsof the right chest and neck.Figure 2 (A) Coronal CT scan reconstruction showingthe thrombosis of the right
internal jugular vein; (B)sagittal CT scan reconstruction showing the length of thevenous occlusion (54.81 mm).Figure 3 Superficial ectasic
veinsof the right chest,shoulder and neck.
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