| A Case of Spontaneous Bleeding from the Branch of Subclavian Artery in a Hemodialysis Patient |
| Chan Sun Park, M.D., Shin Young Lee, M.D., Byeong Chool Park, M.D., Jee In Jeong, M.D. Ho Kil, M.D., Eun Young Choi, M.D., Soon Kil Kwon, M.D. and Hye-Young Kim, M.D. |
| Division of Nephrology, Department of Internal Medicine College of Medicine, Chungbuk National University |
| 증례 : 혈액투석 환자에서 발생한 쇄골하동맥 분지의 자발성 출혈 1예 |
| 박찬선 이신영 박병출 정지인 길 호 최은영 권순길 김혜영 |
| 충북대학교 의과대학 내과학교실 |
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| Abstract |
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In patients undergoing hemodialysis, spontaneous bleedings have been reported in locations such as mediastinum, subdural space, retroperitoneum, pericardial and pleural cavities. A 61 year-old woman had been treated three times a week with maintenance hemodialysis via tunnelled cuffed central venous catheter for 4 months. She had a sudden onset of severe pain on right chest wall 24 hours after maintenance hemodialysis. We found that her right upper chest wall was swollen. Urgent computed tomography revealed a soft tissue mass with high density in right chest wall. The lesion was enhanced by contrast but was not clearly marginated in arterial phase. We did emergent hemodialysis, and did transfusion of packed red blood cells and fresh frozen plasma and compressed locally on her right chest wall. Hematoma was spontaneously resolved only after supportive care. Therapeutic approaches to uremic patients with bleeding disorders include angiography, hemodialysis, peritoneal dialysis, transfusion of packed red cells and fresh frozen plasma, infusion of erythropoietin, desmopressin, conjugated estrogen, etc. In this case, spontaneous bleeding without trauma history can occur in patients with endstage renal disease who underwent hemodialysis using catheter. Therefore, immediate treatment should be followed when evidence of bleeding is found. |
| Key Words:
Hemorrhage, Hemodialysis, Subclavian artery, End-stage renal disease |
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