An Unusual Case of Hematemesis.

Question: A 68-year-old African-American man with history of end-stage renal disease with multiple previous indwelling central venous catheters and current left-side arteriovenous fistula, essential hypertension, and no known history of liver disease presented to the emergency department after an episode of large-volume hematemesis during his routine session of hemodialysis. His blood pressure on presentation was 81/52 with a heart rate of 106 beats per minute. Physical examination was notable for venous distention in the neck and anterior chest wall. His hemoglobin on presentation was 6.6 g/dL.