Recurrent Brachiocephalic Vein Stenosis as a Cause for Persistent Left-sided Transudative Pleural Effusion in a Hemodialysis Patient.
BACKGROUND
Effusion is common in dialysis patients. The most common causes include fluid overload due to renal failure and nonrenal causes like congestive heart failure and infection. We here report a case of left side transudative effusion due to brachiocephalic venous stenosis.


METHODS
A 34-year-old female who had chronic kidney disease V during transplant work-up was found to be having left arm swelling and left transudative effusion. Work-up for transudative effusion did not show any cardiac cause or liver problem. Her dialysis duration was optimized from 2 times a week to 3 times a week for 4 hr and her dry weight was adjusted. Despite adequate dialysis for 1 month, effusion on the left side persisted. She had a previous venoplasty for a stenosis in brachiocephalic vein but restenosis occurred again.


RESULTS
Brachiocephalic vein stenting was performed which successfully lead to resolution of left arm swelling and left effusion. She was later on successfully transplanted.


CONCLUSIONS
Brachiocephalic stenosis can cause ipsilateral transudative effusion. Venoplasty and stenting of the brachiocephalic vein lead to complete resolution of effusion.
Section of Nephrology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan. Electronic address: doctorkhalil1975@hotmail.com.
Muhammad Abdul Mabood
MA
Khalil
Section of Nephrology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
Muhammad Sharoz
MS
Rabbani
Section of Nephrology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
Noor Rehman
NR
Chima
Department of Nephrology, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam.
Jackson
J
Tan
Department of Medicine, Khyber Teaching Hospital, Peshawar, Pakistan.
Muhammad Ashhad Ullah
MA
Khalil
Section of Nephrology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
Zia Ur
ZU
Rehman
D000328:Adult; D001166:Arteriovenous Shunt, Surgical; D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D003251:Constriction, Pathologic; D057510:Endovascular Procedures / Q000295:instrumentation; D005122:Exudates and Transudates; D005260:Female; D006801:Humans; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000209:etiology*; D012008:Recurrence; D006435:Renal Dialysis / Q000009:adverse effects; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D015607:Stents; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D014654:Vascular Patency