Central venous lesions are suspected in dialysis patients who present with increased venous pressure and severe swelling of the shunt arm. Here, we report a case where contrast computed tomography (CT) was useful for diagnosis. Iopamidol 300 (20 mL) was diluted 2-fold, 30 mL of which was injected into the vein in the shunt arm at 2.0 mL/s. Imaging was started 10 s later. Fixed stenosis caused by intimal proliferation can be assessed just as effectively using contrast CT and shunt angiography. However, contrast CT is more useful than shunt angiography in the assessment of stenosis due to compression by surrounding organs and lesions, because the position of vessels relative to surrounding organs can be depicted. Contrast CT allows for safer and shorter examination compared with shunt angiography, and the diagnostic performance of a single examination can be improved using 3-dimensional reconstruction (3D) and multiplanar reformation images. Precise information obtained using contrast CT will contribute to safe and effective percutaneous transluminal angioplasty.