Horner Syndrome After Lymph Node Fine Needle Aspiration

Messika, Orit; Telman, Gregory

doi:10.1159/000325363

Cited by 6 publications

(6 citation statements)

References 5 publications

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“…Similar cases were reported by Orit Messika M.D. of Israel in 2009 4 and Mousa A. Al‐Abbadi in 2010 5 . These cases not only did not analyze the specific causes generated, but also made no suggestions on how to avoid this complication.…”

Section: Introductionsupporting

confidence: 84%

Horner Syndrome subsequent to ultrasound‐guided cervical lymph node fine‐needle aspiration – A case report and literature review

Lin

Zhu

Wang

et al. 2022

J of Clinical Ultrasound

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Horner Syndrome (HS) is characterized by symptoms of ipsilateral miosis, ptosis, enophthalmos, and facial anhidrosis, which is caused by the damaged oculosympathetic pathway. HS is rarely reported as postoperative complications of fine‐needle aspiration (FNA). We report a case of HS triggered by Ultrasound‐guided FNA during thyroid cancer management and conducted the literature review. A 31‐year‐old male with differentiated thyroid cancer underwent total thyroidectomy and regional lymph node dissection as well as radioactive iodine ablation, presented with persistently elevated tumor marker of thyroglobulin and suspicious left level IV and V cervical lymph nodes by neck ultrasound. Ultrasound‐guided left cervical lymph nodes FNA for cellular diagnosis was performed, and typical manifestations of HS appeared immediately after the procedure. Subsequent ultrasound evaluation of the same area demonstrated a subtle strip of the hypo‐echogenic area in the superior pole of the suspected level IV structure, suggesting sympathetic ganglia with the visible originating nerve fiber on the superior pole. All of the patient's symptoms of HS were resolved 2 months after the incidence. Cervical sympathetic ganglia can be similar in size, shape, and ultrasound characteristics to a malignant lymph node. Thorough ultrasound examination by directly comparing the potential ganglia with a typical malignant lymph node, and paying attention to any potential root fibers on the target is key to avoiding ganglia injury before the neck invasive procedures.

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Section: Introductionsupporting

confidence: 84%

Horner Syndrome subsequent to ultrasound‐guided cervical lymph node fine‐needle aspiration – A case report and literature review

Lin

Zhu

Wang

et al. 2022

J of Clinical Ultrasound

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“…There is growing clinical significance of minimally invasive procedure. Owing to its location, the MCSG is sometimes damaged during surgery or various procedures such as neck lymph node biopsy, ethanol ablation (EA), and radiofrequency ablation (RFA) of thyroid tumors (2)(3)(4)(5)(6). Knowing relevant anatomy and meticulous inspection using ultrasound (US) before procedures, such as nerve blocks or RFAs, is needed to reduce procedure-related complications.…”

Section: Data Extractionmentioning

confidence: 99%

Characteristics of the Middle Cervical Sympathetic Ganglion: A Systematic Review and Meta-Analysis

et al. 2018

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Background: Understanding the characteristics of the middle cervical sympathetic ganglion (MCSG) may minimize procedure-related complications and maximize efficacy during surgery or ultrasound (US)-guided procedures. The location and detection rate of the MCSG were variable in small population studies. Therefore, a large population study or meta-analysis could give more information about the MCSG. Objectives: We aim to review the published literature and evaluate the anatomical features of the MCSG, including the detection rate, location, size, and a normal variation, and to review the clinical relevance of MCSG for procedures including, US-guided ganglion block, ethanol ablation (EA), or radiofrequency ablation (RFA). Study Design: A systematic review and meta-analysis. The Ovid-MEDLINE and EMBASE databases were searched to find the detection rate, location, and other characteristics of the MCSG. Setting: The pooled proportions for the detection rate of the MCSG were assessed using the DerSimonian-Laird random-effects model. Methods: Heterogeneity among the studies was determined using a chi-square analysis for the pooled estimates and inconsistency index (I2 ). In order to reduce the heterogeneity, sensitivity analyses were performed. Results: A review of 542 studies identified 8 eligible studies, with 273 MCSGs included in the meta-analysis. The pooled proportion for the detection rate of the MCSG was 50.4% (95% confidence interval [CI], 34.5–66.4%). Considerable heterogeneity among the studies was observed (I2 = 94.9%). In the sensitivity analysis, when excluding one study, heterogeneity was reduced with a recalculated pooled proportion of 44.2% (95% CI, 32.1–56.2%; I2 = 86.0%). The location of the MCSG is usually posterior to the carotid sheath and anterior to the longus colli muscle at the level of the C3–C7 vertebrae. There was a variant where the cervical sympathetic trunk was located at the posterior wall of the carotid sheath and was adherent to the sheath. The size of the MCSG is as follows: the width, length, and height ranges were 3.8–6.3 mm, 6.3–10.5 mm, and 1.7–2.1 mm, respectively. A specific type of MCSG, referred to as the “double middle cervical ganglion”, consisting of 2 ganglia, was demonstrated in 3 studies with a detection rate of 2.9–10%. Limitations: This meta-analysis included a relatively small number of studies. Significant heterogeneity was also present in the detection rate of MCSG in these studies. There was a lack of concentrated information about the MCSG, because the majority of the included studies focused on the entire cervical sympathetic chain, not only MCSG primarily. Improving complication rates might be limited due to the approximate 50% detection rate. Conclusion: Understanding the characteristics and variations of the MCSG could minimize complications and maximize efficacy during surgery and US-guided procedures. Key words: Middle cervical sympathetic ganglion, cervical sympathetic trunk, cervical sympathetic chain, ultrasound, nerve block, ethanol ablation, radiofrequency ablation, thyroid, Horner syndrome, meta-analysis

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“…Medial to the CCA, the middle CSG closely adjacent to the thyroid gland, and could be damaged during RF ablation near the lateral margin of benign thyroid nodules ( Fig. 10 ) ( 40 43 44 ).…”

Section: Nervous Systemmentioning

confidence: 99%

Ultrasonography-Based Thyroidal and Perithyroidal Anatomy and Its Clinical Significance

2015

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Ultrasonography (US)-guided procedures such as ethanol ablation, radiofrequency ablation, laser ablation, selective nerve block, and core needle biopsy have been widely applied in the diagnosis and management of thyroid and neck lesions. For a safe and effective US-guided procedure, knowledge of neck anatomy, particularly that of the nerves, vessels, and other critical structures, is essential. However, most previous reports evaluated neck anatomy based on cadavers, computed tomography, or magnetic resonance imaging rather than US. Therefore, the aim of this article was to elucidate US-based thyroidal and perithyroidal anatomy, as well as its clinical significance in the use of prevention techniques for complications during the US-guided procedures. Knowledge of these areas may be helpful for maximizing the efficacy and minimizing the complications of US-guided procedures for the thyroid and other neck lesions.

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Horner Syndrome After Lymph Node Fine Needle Aspiration

Cited by 6 publications

References 5 publications

Horner Syndrome subsequent to ultrasound‐guided cervical lymph node fine‐needle aspiration – A case report and literature review

Horner Syndrome subsequent to ultrasound‐guided cervical lymph node fine‐needle aspiration – A case report and literature review

Characteristics of the Middle Cervical Sympathetic Ganglion: A Systematic Review and Meta-Analysis

Ultrasonography-Based Thyroidal and Perithyroidal Anatomy and Its Clinical Significance

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