Renal

Advanced Practice: Thoracic Central Venous Obstruction!

A 25 yo male with a hx of ESRD due to membranoproliferative glomerulonephritis (MPGN) presents to the ED with complaints of swelling to his LUE, face, and neck progressive over 5 days. He was seen at another ED 2 days prior and had an ultrasound of his LUE fistula as well as a duplex of his LUE which were unremarkable.  A CT scan of the chest was ordered, revealing bilateral occluded brachiocephalic veins, which were treated in the interventional radiology suite with balloon venoplasty with resultant resolution of edema.

Category (Day): 

Chvostek’s Sign + Hypocalcemia

Chvostek’s sign is momentary contraction of the nose and/or lips in response to tapping the facial nerve at the angle of the jaw.  Associated with hypocalcemia, it has been found to be poorly sensitive and specific.  It is seen in 10-25% of healthy individuals with normal calcium levels, whereas approximately one third of patients with hypocalcemia will not demonstrate this sign.

Category (Day):