The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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An Unusual Cause of Left Brachiocephalic Vein Occlusion: Extrinsic Compression by the Aortic Arch in a Hemodialysis Patient

혈액투석 환자에서 대동맥궁에 의한 좌완두정맥의 외부 압박

  • Nam, Hee Chul (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Kang, Seung Hun (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Kim, Yeon-Ji (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Lee, Su Lim (Department of Radiology, The Catholic University of Korea College of Medicine) ;
  • Kim, Young-Ok (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Yoon, Sun Ae (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Yun, Yu-Seon (Department of Internal Medicine, The Catholic University of Korea College of Medicine)
  • 남희철 (가톨릭대학교 의과대학 내과학교실) ;
  • 강승훈 (가톨릭대학교 의과대학 내과학교실) ;
  • 김연지 (가톨릭대학교 의과대학 내과학교실) ;
  • 이수림 (가톨릭대학교 의과대학 영상의학교실) ;
  • 김영옥 (가톨릭대학교 의과대학 내과학교실) ;
  • 윤선애 (가톨릭대학교 의과대학 내과학교실) ;
  • 윤유선 (가톨릭대학교 의과대학 내과학교실)
  • Received : 2012.08.13
  • Accepted : 2012.10.22
  • Published : 2013.04.01
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Abstract

The most common cause of central venous obstruction including left braciocephalic vein is intrinsic stenosis associated with a previous central venous catheter or other devices. Occasionally, patients with no history of central venous catheterization present with left brachiocephalic vein occlusion. This occurs as a result of extrinsic compression of the brachiocephalic vein by adjacent vascular structures, especially the aortic arch and its branches. Here, we report a case of left brachiocephalic vein compression caused by a tortuous, ectatic aortic arch in a patient with no history of central vein catheterization. To our knowledge, this is the first report of extrinsic compression of the brachiocephalic vein by the aortic arch in Korea.

환자는 중심정맥 삽관술의 과거력 및 중심정맥 폐쇄와 관련된 증상은 없었으나 동정맥루 조성술 전 시행한 혈관조영술과 흉부 컴퓨터촬영을 통하여 외부 압박에 의한 중심정맥 폐쇄가 진단되었다. 중심정맥 삽관술의 과거력 없이 중심정맥 폐쇄가 발생하는 빈도는 낮고 외부 압박에 의한 경우 또한 드물지만 본 증례의 환자와 같이 무증상의 중심정맥 폐쇄가 있을 수 있으므로 동정맥루 조성술을 계획한다면 증상이 없더라도 중심정맥 폐쇄의 가능성에 대해 고려해야 한다. 특히 대동맥궁의 심한 확장을 보이며 흉부 전산화단층촬영에서 좌완두정맥이 압박된 소견이 관찰된다면 혈관 조영술을 시행하여 혈관 폐쇄 여부를 확인하는 것이 필요하다.

Keywords

References

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