Tunneled Dialysis Catheter placement induced Budd Chiari Syndrome and Cirrhosis of Liver
Speaker Credentials
MD
Format
Poster
Start Date
6-11-2020 11:45 AM
End Date
6-11-2020 12:00 PM
Abstract
A 76 year old female presented with weakness and abdominal pains for 1 week. She reported two episodes of coffee ground emesis and significant amount of weight loss as well. She has a history of diabetes mellitus type 2, hypertension, end stage renal disease on hemodialysis and colonic perforation at the site of a stercoral ulcer needing left hemicolectomy and colostomy. She had a tunneled dialysis catheter placed about one year ago in her right internal jugular vein. Her vitals were stable. BMI 17.3. On physical examination, she was found to be cachectic and had tensely distended abdomen. Healthy appearing colostomy site present on abdomen as well. On laboratory evaluation, she had thrombocytopenia, elevated creatinine and elevated liver enzymes. CT scan of the abdomen and pelvis without IV or PO contrast revealed cirrhosis of the liver with moderate ascites. Paracentesis was done and 2.5 L of fluid was removed. Based on the ascitic fluid analysis, she either had Budd Chiari syndrome or Cardiac ascites. Echocardiogram revealed normal cardiac function. Upper endoscopy revealed no varices but esophagitis, gastritis and duodenitis. For evaluation of the Budd Chiari syndrome, MRI abdomen with intravenous contrast was done. It revealed partial versus complete thrombosis of the intrahepatic IVC towards the cavoatrial junction confirming Budd Chiari Syndrome. Venography revealed total complete occlusion of the IVC at the level of the diaphragm. This case raises awareness and importance of timely removal of the tunneled dialysis catheter and about its potential complication specifically Budd Chiari syndrome.
Tunneled Dialysis Catheter placement induced Budd Chiari Syndrome and Cirrhosis of Liver
A 76 year old female presented with weakness and abdominal pains for 1 week. She reported two episodes of coffee ground emesis and significant amount of weight loss as well. She has a history of diabetes mellitus type 2, hypertension, end stage renal disease on hemodialysis and colonic perforation at the site of a stercoral ulcer needing left hemicolectomy and colostomy. She had a tunneled dialysis catheter placed about one year ago in her right internal jugular vein. Her vitals were stable. BMI 17.3. On physical examination, she was found to be cachectic and had tensely distended abdomen. Healthy appearing colostomy site present on abdomen as well. On laboratory evaluation, she had thrombocytopenia, elevated creatinine and elevated liver enzymes. CT scan of the abdomen and pelvis without IV or PO contrast revealed cirrhosis of the liver with moderate ascites. Paracentesis was done and 2.5 L of fluid was removed. Based on the ascitic fluid analysis, she either had Budd Chiari syndrome or Cardiac ascites. Echocardiogram revealed normal cardiac function. Upper endoscopy revealed no varices but esophagitis, gastritis and duodenitis. For evaluation of the Budd Chiari syndrome, MRI abdomen with intravenous contrast was done. It revealed partial versus complete thrombosis of the intrahepatic IVC towards the cavoatrial junction confirming Budd Chiari Syndrome. Venography revealed total complete occlusion of the IVC at the level of the diaphragm. This case raises awareness and importance of timely removal of the tunneled dialysis catheter and about its potential complication specifically Budd Chiari syndrome.