Angiectasia of the parietal pleura in a hemodialysis patient with central venous stenosis and bloody pleural effusion: a
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CASE REPORT
Angiectasia of the parietal pleura in a hemodialysis patient with central venous stenosis and bloody pleural effusion: a case report Yasuhiro Mochida1 · Takayasu Ohtake1 · Kunihiro Ishioka1 · Katsunori Miyake1 · Hidekazu Moriya1 · Sumi Hidaka1 · Shuzo Kobayashi1 Received: 18 September 2019 / Accepted: 19 August 2020 © Japanese Society of Nephrology 2020
Abstract Pleural effusion in hospitalized patients with long-term hemodialysis (HD) has been frequently reported. The most common causes of unilateral pleural effusions include hypervolemia, parapneumonic, uremic effusion, and malignancy. In contrast, central venous stenosis (CVS) has rarely been shown to result in pleural effusion. CVS is often diagnosed by percutaneous angiography, yet there are no reports of cases where percutaneous angiography missed CVS and instead intrathoracic endoscopy was performed. Herein, we report a case of CVS with angiectasia of the parietal pleura detected on intrathoracic endoscopy. A 62-year-old man with HD presented with massive unilateral pleural effusion. Although the cause of pleural effusion was suspected to be CVS, percutaneous angiography did not show apparent stenosis, and as a result, other potential causes of bloody effusion were investigated. The intrapleural cavity was assessed using intrathoracic endoscopy, which revealed angiectasia and no malignancy. As these findings might be suggestive of congestive and dilated vessels with venous stenosis or occlusion, 3D-computed tomography (CT) scans were performed instead of percutaneous angiography to determine whether a stenosis or occlusion was present. Brachiocephalic vein stenosis was found near the aortic arch. CVS was treated through ligation of the arteriovenous fistula (AVF), resulting in a dramatic decrease in the left pleural effusion. This case would suggest that CVS should be suspected when angiectasia of the parietal pleura is observed in HD patients. In addition, the benefit of utilizing 3D-CT should be considered when HD patients present with a unilateral hemothorax on the same side as that of the AVF, particularly when on the left side. Keywords Central vein stenosis · 3-D computed tomography · Pleural effusion · Hemodialysis · Hemothorax
Introduction The overall incidence of pleural effusions in hospitalized patients undergoing long-term hemodialysis (HD) has been shown to be around 20% [1]. Unilateral pleural effusions have been reported in about 50% of patients with pleural effusion. The most common causes of unilateral pleural effusions are hypervolemia, parapneumonic, and uremic effusion [1, 2], whereas the most common causes of hemothorax were found to be malignancy and tuberculosis. End-stage renal failure patients who need HD often suffer from central vein stenosis (CVS) due to catheter device, which is
inserted to start dialysis emergently for patients without an arteriovenous fistula (AVF) [3, 4]. However, cases of pleural effusion and hemothorax caused by central vein stenosis (CVS) on the same side as that of the AVF are rare [5–13],
