The difficult distinction between haemolytic uraemic syndrome and thrombotic thrombocytopenic purpura

in the visceral pleura. In our case, it is likely there was impaired lymphatic absorption as the high venous pressure, resulting from the brachiocephalic stenosis, would impair lymphatic drainage from the right thoracic duct. Additionally, it is possible that there was increased pleural fluid production due to increased venous pressure of the parietal pleural capillaries, which ultimately drain into the SVC. In conclusion, the finding of a pleural effusion with ipsilateral arm and breast oedema in a dialysis patient with an arteriovenous fistula should prompt investigation for a central venous stenosis.