Abstract
Vascular lesions due to subclavian and internal jugular vein puncture may result in hematomas, which are usually clinically evident. While mostly benign, some of these hematomas can cause compression of the surrounding structures. When the hematoma is obvious, straightforward correlation can be made between the symptoms, for instance nerve compression, and the clinical signs. We present a case where we missed the diagnosis, of phrenic nerve paralysis, which occurred after an unsuccessful, but apparently atraumatic attempt to puncture the internal jugular vein, prior to cardiac surgery. At the time the diagnosis was made (8 days post-op), the radiographic apperence of the neck was normal, and further investigation (i.e., CT-scan) had become pointless. A retrospective study of serial chest X-rays disclosed a space occupying lesion in the right lateral neck that displaced the nasogastric tube. This abnormality could only be seen on the first film and disappeared on the following. Since phrenic nerve paralysis is extremely rare in our institution, even after cardiac surgery, and as there was no clinical evidence of hematoma, our attention was not been drawn to the only definite sign that could have led to an early diagnosis.
Similar content being viewed by others
References
Brandt L, Reissmann H, Pokar H (1983) Phrenic nerve paralysis after cannulation of the internal jugular vein. Anaesthesist 32:234
Belani KG, Buckley JJ, Gordon JR, Castaneda W (1980) Percutaneous cervical central venous line placement: a comparison of the internal and external jugular vein routes. Anesth Analg 59:40
Briscoe CE, Bushman JA, McDonald WI (1974) Extensive neurological damage after cannulation of internal jugular vein. Br Med J 1:314
Defalque RJ (1974) Percutaneous catherization of the internal jugular vein. Anesth Analg 53:116
Fischer RG, Hödlock F, Ben-Menechem Y (1981) Laceration of the thoracic aorta and bronchiocephalic arteries by blunt trauma. Radiol Clin North Am 19:91
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Depierraz, B., Essinger, A., Morin, D. et al. Isolated phrenic nerve injury after apparently atraumatic puncture of the internal jugular vein. Intensive Care Med 15, 132–134 (1989). https://doi.org/10.1007/BF00295992
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00295992