Superior vena caval thrombosis complicating central venous catheterisation and total parenteral nutrition.

Although venous thrombosis is a common sequela of central venous catheterisation, the vast majority of patients remain asymptomatic. Possible aetiological factors include catheter material, catheter-related sepsis, endothelial trauma, osmotic injury, and hypercoagulable states. Of these, only the first and last have been proven to increase the incidence. Thrombosis of the great veins of the thorax is a rare but life-threatening complication and the diagnosis is suggested by swelling of the head, upper limbs, and torso. Mediastinal widening on plain chest radiography may precede these signs. Confirmation of thrombosis is best achieved using contrast venography or contrast-enhanced CT scan. Acute symptomatic thrombosis is probably best treated by thrombolytic agents, but anticoagulation remains the commonest therapeutic approach.