LAUSR

A 28-year-old woman with ESRD due to hypertension presented to the emergency room with a 2-day history of pain and swelling on the left side of her neck and jaw. She denied any inciting factors prior to symptoms, but relayed that her dialysis treatment could not be performed through her left-sided upper arm Hemodialysis Reliable Outflow (HeRO) (Merit Medical Systems, Inc., South Jordan, UT, USA) graft the prior day as it had appeared to have clotted. On physical examination the patient had a markedly edematous left neck with a large tender palpable mass. Her vital signs were normal, no bruit or thrill was appreciated over her AVG site, and no other obvious findings were appreciated. A computed tomography (CT) scan of the neck revealed a large hematoma within the left sternocleidomastoid muscle (Figure 1). Concerns about the integrity of the HeRO graft prompted a chest radiograph (CXR), which was compared to previous imaging collected 1 month earlier (Figures 2A— 1 month ago, and 2B—present).