Budd-Chiari syndrome secondary to catheter-associated inferior vena cava thrombosis

Abstract Introduction: Patients with chronic kidney disease (CKD) are at increased risk for thrombotic complications. The use of central venous catheters as dialysis vascular access additionally increases this risk. We describe the first case of Budd-Chiari syndrome (BCS) secondary to central venous catheter misplacement in a patient with CKD. Case report: A 30-year-old female patient with HIV/AIDS and CKD on hemodialysis was admitted to the emergency room for complaints of fever, prostration, and headache in the last six days. She had a tunneled dialysis catheter placed at the left jugular vein. The diagnosis of BCS was established by abdominal computed tomography that showed a partial thrombus within the inferior vena cava which extended from the right atrium to medium hepatic vein, and continuing along the left hepatic vein. Patient was treated with anticoagulants and discharged asymptomatic. Discussion: Budd-Chiari syndrome is a rare medical condition caused by hepatic veins thrombosis. It can involve one, two, or all three of the major hepatic veins. It is usually related to myeloproliferative disorders, malignancy and hypercoagulable states. This case calls attention for inadvertent catheter tip placement into hepatic vein leading to this rare complication. Conclusion: Assessment of catheter dialysis tip location with radiological image seems to be a prudent measure after each procedure even if the tunneled dialysis catheter has been introduced with fluoroscopy image.引言：慢性肾脏病（chronic kidney disease, CKD）患者发生血栓并发症的风险显著升高。将中心静脉导管（central venous catheter）用作透析血管通路，会进一步增加该风险。本文报道1例慢性肾脏病患者因中心静脉导管异位继发布-加综合征（Budd-Chiari syndrome, BCS）的首例病例。 病例报告：1例30岁女性艾滋病（HIV/AIDS）合并慢性肾脏病且行血液透析的患者，因近6天出现发热、全身乏力、头痛就诊于急诊。该患者左侧颈内静脉置入了隧道式透析导管（tunneled dialysis catheter）。腹部计算机断层扫描（computed tomography, CT）显示，下腔静脉内存在部分血栓，血栓从右心房延伸至肝中静脉，并沿左肝静脉延续，据此确诊布-加综合征。患者接受抗凝治疗后症状消失并出院。 讨论：布-加综合征是一种由肝静脉血栓形成引发的罕见疾病，可累及1支、2支或全部3支主要肝静脉。其发病通常与骨髓增殖性疾病、恶性肿瘤及高凝状态相关。本病例提醒临床医师需警惕导管尖端意外置入肝静脉所导致的这一罕见并发症。 结论：即便隧道式透析导管是在透视（fluoroscopy）引导下置入的，每次操作完成后仍应通过影像学检查评估透析导管尖端的位置，此举实属审慎之举。