Korean J Nephrol.  2007 Nov;26(6):792-796.

A Case of Spontaneous Bleeding from the Branch of Subclavian Artery in a Hemodialysis Patient

• Park CS
• Lee SY
• Park BC
• Jeong JI
• Kil H
• Choi EY
• Kwon SK
• Kim HY

Abstract

In patients undergoing hemodialysis, spontaneous bleedings have been reported in locations such as mediastinum, subdural space, retroperitoneum, pericardial and pleural cavities. A 61 year-old woman had been treated three times a week with maintenance hemodialysis via tunnelled cuffed central venous catheter for 4 months. She had a sudden onset of severe pain on right chest wall 24 hours after maintenance hemodialysis. We found that her right upper chest wall was swollen. Urgent computed tomography revealed a soft tissue mass with high density in right chest wall. The lesion was enhanced by contrast but was not clearly marginated in arterial phase. We did emergent hemodialysis, and did transfusion of packed red blood cells and fresh frozen plasma and compressed locally on her right chest wall. Hematoma was spontaneously resolved only after supportive care. Therapeutic approaches to uremic patients with bleeding disorders include angiography, hemodialysis, peritoneal dialysis, transfusion of packed red cells and fresh frozen plasma, infusion of erythropoietin, desmopressin, conjugated estrogen, etc. In this case, spontaneous bleeding without trauma history can occur in patients with endstage renal disease who underwent hemodialysis using catheter. Therefore, immediate treatment should be followed when evidence of bleeding is found.

Keyword

Hemorrhage; Hemodialysis; Subclavian artery; End-stage renal disease

MeSH Terms

Angiography
Catheters
Central Venous Catheters
Deamino Arginine Vasopressin
Erythrocytes
Erythropoietin
Estrogens
Female
Hematoma
Hemorrhage*
Humans
Kidney Failure, Chronic
Mediastinum
Middle Aged
Peritoneal Dialysis
Plasma
Pleural Cavity
Renal Dialysis*
Subclavian Artery*
Subdural Space
Thoracic Wall
Deamino Arginine Vasopressin
Erythropoietin
Estrogens