SHM Converge Scientific Abstract ePoster Gallery-Brachiocephalic Vein Stenosis Presenting With Atypical Breast Swelling

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This case describes a 20-year-old woman with systemic lupus erythematosus and end-stage renal disease on hemodialysis through a left upper extremity arteriovenous graft who presented with pain, redness, and swelling of the right inferior breast. She was initially treated for cellulitis, and the erythema improved, but the breast swelling progressed and became increasingly painful, eventually extending to the right upper extremity. Exam showed a grossly enlarged, firm, diffusely tender right breast without discharge, focal mass, or fluctuance.<br /><br />Ultrasound showed skin thickening and edema, and duplex ultrasound was negative for upper extremity DVT. CT venography later revealed an occluded right brachiocephalic vein with multiple collateral vessels, including the right internal mammary vein, as well as a right pleural effusion. Her symptoms improved with fluid and salt restriction, compression bra use, and repeated ultrafiltration.<br /><br />The discussion highlights that central venous stenosis is a known complication in hemodialysis patients, often related to prior central venous catheters or devices, and may affect up to 40% of patients. While unilateral breast swelling is a rare presentation, it has been reported in association with central venous stenosis or occlusion. In this patient, volume overload from ESRD and nonadherence to fluid/salt restriction likely worsened the edema, with blood being diverted through narrow collateral veins and leaking into breast tissue.<br /><br />The key conclusion is that unilateral breast swelling in patients with a history of dialysis access or central venous instrumentation should prompt evaluation for central venous stenosis. Early recognition is important to avoid misdiagnosis and to guide appropriate management.

Asset Subtitle

Kalemelekot Taye

Meta Tag

Author List Kalemelekot Taye, Nathan Garner, Ryann Sohaney

Category Clinical Vignettes

Concept Central Venous Stenosis

Concept Hemodialysis Access

Concept Unilateral Breast Swelling

Concept Vascular Access Preservation

Concept Intravascular Device

Distinguished Non-Finalist

Presenter Organization Wayne State University School of Medicine

Presenting Author Kalemelekot Taye

Track Adult

Keywords

systemic lupus erythematosus

end-stage renal disease

hemodialysis

unilateral breast swelling

central venous stenosis

brachiocephalic vein occlusion

arteriovenous graft

collateral veins

volume overload

dialysis access

Central Venous Stenosis

Hemodialysis Access

Unilateral Breast Swelling

Vascular Access Preservation

Intravascular Device