Central venous hemodialysis catheter applications are still the most common route for acute hemodialysis and some complications may be seen at the time of insertion or later and some of these may be fatal. Catheter malpositions and great vessel perforations have an important place among these complications. Vessel perforations may be fatal if not diagnosed in the early period and treated appropriately and may share the same symptomatology with other acute dialysis complications such as anaphylactic reactions, air embolism and acute coronary syndromes. We discuss chest pain occurring at the onset of dialysis in a patient with left brachiocephalic vein perforation and its similarities with the symptoms of other dialysis complications. keY wordS: Brachiocephalic vein, Hemodialysis, Perforation