Superior vena cava syndrome secondary to indwelling peripherally inserted perm-catheter in 33-year-old female

Abstract

We report a case of acute onset superior vena cava (SVC) syndrome secondary to long-term indwelling catheter, utilized for dialysis in a patient during a previous hospital stay, and a review of literature. The patient is a 33-year-old female with a past medical history of Type 1 diabetes, hypertension, end stage renal disease, cerebral vascular accident (CVA), and peripheral artery disease presenting with acute onset of facial, neck, and upper extremity swelling with decreased oxygen saturation. Symptoms of SVC syndrome include swelling of the face, neck, and upper extremity. In addition, there is prominent facial edema and flushing, with jugular venous distension that is exacerbated when the arms are placed over the head. Diagnosis includes a thorough clinical exam with imaging modalities for confirmative diagnosis. Options include noninvasive imaging such as ultrasound, which is preferred for peripheral venous obstruction, while magnetic resonance angiography (MRA) and computed tomography angiography (CTA) can confirm central obstruction. Treatment due to stenosis by catheter involves stenting with balloon angioplasty which can provide immediate relief of symptoms. High degree of suspicion for superior vena cava syndrome should arise when a patient presents with common symptoms and long-term central lines. This case demonstrates the long-term effects of indwelling catheters on patients with pre-existing vascular and renal disease.