Unilateral Breast Edema as a Rare Manifestation of Brachiocephalic Vein Occlusion in a Hemodialysis Patient.

Source: PubMed, NCBI / U.S. National Library of Medicine

Central venous stenosis and occlusion are recognized complications in hemodialysis patients and commonly present with ipsilateral arm, neck, or facial swelling. Unilateral breast edema is an uncommon manifestation that may mimic primary breast disorders and delay diagnosis. A 58-year-old woman with end-stage kidney disease receiving maintenance hemodialysis through a left-arm arteriovenous fistula presented with progressive unilateral left breast swelling accompanied by ipsilateral arm edema and facial congestion. Clinical evaluation excluded infection, malignancy, and lymphedema. Duplex ultrasonography suggested a central venous abnormality, and venography demonstrated complete occlusion of the left brachiocephalic vein with extensive collateral venous circulation. Endovascular treatment was performed with balloon angioplasty followed by self-expanding stent implantation because of significant elastic recoil. Post-procedural venography confirmed restoration of venous flow. The patient experienced rapid improvement in breast, arm, and facial swelling, with near-complete resolution at 1-month follow-up while maintaining functional dialysis access. Central venous obstruction should be considered in the differential diagnosis of unilateral breast swelling in hemodialysis patients. Prompt recognition and endovascular intervention can provide effective symptom relief, prevent unnecessary diagnostic procedures, and preserve vascular access.