open access

Vol 47, No 4 (2015)
Case reports
Submitted: 2015-09-20
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Horner syndrome after unsuccessful venous port implantation by cannulation of the right internal jugular vein

Łukasz R. Nowak, Krzysztof Duda, Marek Mizianty, Małgorzata Wilczek, Tomasz Bieda
DOI: 10.5603/AIT.2015.0049
·
Anaesthesiol Intensive Ther 2015;47(4):336-338.

open access

Vol 47, No 4 (2015)
Case reports
Submitted: 2015-09-20

Abstract

BACKGROUND: Horner syndrome is a rare but likely underdiagnosed complication of internal jugular vein cannulation.

CASE REPORT: We present a case of a young woman undergoing chemotherapy for gestational trophoblastic disease for whom venous port implantation was attempted due to poor peripheral vein access. Despite ultrasound guidance, the procedure was unsuccessful and complicated by a local haematoma, causing compression of the sympathetic nerves with Horner syndrome. The symptoms subsided within 3 weeks without treatment. The possible pathomechanisms of Horner syndrome after central venous cannulation are presented with suggested diagnostic and therapeutic approaches. Special emphasis must be placed on excluding carotid artery dissection because it carries the risk of subsequent cerebral vascular incidents. In the event of a carotid dissection, a multidisciplinary team must choose a pharmacological (antiplatelet drugs/anticoagulation) or interventional approach.

CONCLUSION: Even with ultrasonography, central venous cannulation is not free of serious risks. In case of anisocoria following an uneventful procedure, diagnostic imaging of the vascular structures in the neck is mandatory for the exclusion of potentially serious complications, such as carotid dissection or venous thrombosis.

Abstract

BACKGROUND: Horner syndrome is a rare but likely underdiagnosed complication of internal jugular vein cannulation.

CASE REPORT: We present a case of a young woman undergoing chemotherapy for gestational trophoblastic disease for whom venous port implantation was attempted due to poor peripheral vein access. Despite ultrasound guidance, the procedure was unsuccessful and complicated by a local haematoma, causing compression of the sympathetic nerves with Horner syndrome. The symptoms subsided within 3 weeks without treatment. The possible pathomechanisms of Horner syndrome after central venous cannulation are presented with suggested diagnostic and therapeutic approaches. Special emphasis must be placed on excluding carotid artery dissection because it carries the risk of subsequent cerebral vascular incidents. In the event of a carotid dissection, a multidisciplinary team must choose a pharmacological (antiplatelet drugs/anticoagulation) or interventional approach.

CONCLUSION: Even with ultrasonography, central venous cannulation is not free of serious risks. In case of anisocoria following an uneventful procedure, diagnostic imaging of the vascular structures in the neck is mandatory for the exclusion of potentially serious complications, such as carotid dissection or venous thrombosis.

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Keywords

central venous cannulation, complications; sympathetic nervous system, Horner syndrome

About this article
Title

Horner syndrome after unsuccessful venous port implantation by cannulation of the right internal jugular vein

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 47, No 4 (2015)

Pages

336-338

DOI

10.5603/AIT.2015.0049

Bibliographic record

Anaesthesiol Intensive Ther 2015;47(4):336-338.

Keywords

central venous cannulation
complications
sympathetic nervous system
Horner syndrome

Authors

Łukasz R. Nowak
Krzysztof Duda
Marek Mizianty
Małgorzata Wilczek
Tomasz Bieda

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