Presentation
Pain in area of arteriovenous dialysis fistula.
Patient Data
Thrombosed brachial artery just proximal to brachiocephalic fistula, with marked edema of subcutaneous fat. Both artery and vein are ectatic.
Case Discussion
Patient with end-stage renal disease (ESRD), history of idiopathic thrombocytopenic purpura (ITP). Had undergone splenectomy for splenomegaly. On hemodialysis for the past year. Arrived at the hospital where she had her dialysis treatment, complaining of pain, swelling, and redness around her arteriovenous fistula. As the radiology resident on night duty was not sufficiently versed in upper limb Doppler ultrasonography, it was decided to perform a contrast-enhanced CT, which showed brachial artery thrombosis. The on-call nephrologist started her on enoxaparin (a low-molecular-weight heparin) treatment.