Recurrent face and neck edema in a patient on long-term hemodialysis

We report the case of a patient undergoing long-term hemodialysis admitted to hospital for diagnosis of recurrent face and neck edema influenced by di alysis sessions with paroxysmal dyspnea. We considered the possible role of allergy to ethylene oxide and to formaldehyde without diagnostic confirmat ion. Dialyzer complement activation was suspected but changing the dialyzer did not improve the symptoms. Anti-histaminic and corticosteroid therapy d id not modify symptoms. A mild hemithoracic collateral circulation occurred and led to the discovery of a superior vena cava syndrome. Computed tomogr aphy and bilateral upper limb contrast venography visualized a thrombus in the superior vena cava extending into the right venous brachiocephalic arm from the central vein catheter. A stent was inserted into the superior vena cava which, together with anticoagulant therapy, led to rapid resolution o f the symptoms. Superior vena cava syndrome related to a central catheter a nd hypersensitivity reactions should always be considered as possible cause s of recurrent face and neck edema in patients on long-term hemodialysis.