title: Postoperative edema after vascular access causing nerve compression secondary to the presence of a perineuronal lipoma: case report.
abstract: OBJECTIVE
  Median nerve neuropathy can be clinically devastating to a patient. It can be caused by compression of the median nerve anywhere along its course. We present the case of delayed median nerve neuropathy after the placement of a vascular graft in the arm.
  
  
  METHODS
  An arm shunt was placed in the nondominant upper extremity in a 60-year-old man with end-stage renal disease. Twelve hours postoperatively, the patient developed neurapraxia in the median nerve distribution in the hand.
  
  
  METHODS
  Exploration of the arm revealed a lipoma coursing along and deep to the median nerve. Resection of the lipoma decompressed the nerve.
  
  
  CONCLUSIONS
  In this patient, median nerve neuropathy was caused by a lipoma and postoperative swelling from placement of the vascular graft. The swelling that occurred after the shunt placement unmasked subclinical compression of the nerve by a lipoma deep to the median nerve. To our knowledge, this report is unique in documenting damage to the median nerve after vascular graft placement as a result of an occult mass.
authors.affiliation: Department of Surgery, University of California at Davis-East Bay and Alameda County Medical Center, Oakland, California 94602, USA. goldstein@pol.net
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Goldstein
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Helfend
authors.forename: Rouzbeh K
authors.initials: RK
authors.lastname: Kordestani
mesh_terms: D001132:Arm / Q000098:blood supply; D001166:Arteriovenous Shunt, Surgical; D019917:Blood Vessel Prosthesis Implantation; D003937:Diagnosis, Differential; D004487:Edema / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008067:Lipoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D008297:Male; D008475:Median Nerve / Q000473:pathology / Q000601:surgery; D020423:Median Neuropathy / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D010524:Peripheral Nervous System Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D006435:Renal Dialysis