Right‐sided chest pain at the onset of haemodialysis

(Section Editor: K. Kühn) Frequent causes of acute chest pain in patients undergoing haemodialysis include acute myocardial infarction, pericarditis, pleuritis, air embolism, and gastro‐oesophageal reflux. Rare causes due to complications after insertion of a central venous catheter, such as pneumothorax, haematothorax, and mediastinal haematoma, can be detected by chest X‐ray. This case report illustrates a rare late complication that occurred 13 days after insertion of an internal jugular‐vein catheter. A 62‐year‐old Caucasian male suffered from chronic renal insufficiency due to suspected cyclosporin toxicity following a liver transplantation performed 3 years previously. His past medical history was significant for liver cirrhosis and subsequent development of a hepatocellular carcinoma caused by a chronic hepatitis C infection. The current immunosuppressive regimen consisted of tacrolimus and steroids. The patient also suffered from arterial hypertension, insulin‐dependent diabetes mellitus, psoriasis, prostate hyperplasia, and kidney stones. He was admitted to the hospital for treatment of ascites and chronic renal failure. A central line was placed in the right internal jugular vein for monitoring of central venous pressure. Because conservative treatment failed to stabilize renal function, the patient was given a left internal jugular single‐lumen catheter for temporary dialysis access. Dialysis treatment was initiated. A routine chest X‐ray revealed the satisfactory position of the catheter (Figure 1). The patient then underwent six haemodialysis sessions without further problems. During the seventh dialysis session, a new native Cimino fistula was used for the arterial blood line and the jugular catheter was used for the venous blood line. Routine physical examination of the immobilized patient before haemodialysis revealed reduced nutritional status, generalized jaundice, ascites, and tachycardia. Blood pressure was 161/102 mmHg. Auscultation of the lung revealed a slight decrease of breathing sounds bilaterally.