경부 림프절 절제생검술 후 상완신경총 손상으로 오진된 척수부신경 손상 1예
Spinal Accessory Nerve Injury Misdiagnosed as Brachial Plexus Injury after Cervical Lymph Node Excisional Biopsy
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초록
Spinal accessory nerve (SAN) injury is one of the complications of neck dissection especially for posterior trian- gle lymph node biopsy and results in shoulder dysfunction and chronic pain. Variations in innervation pattern of SAN to the trapezius muscle may lead to a variable clinical presentation from patient to patient and may confuse the diagnosis. Therefore in patients with possible SAN injury, it is important to recognize the clinical symptom and determine whether the patient should have surgical treatment or conservative treatment. A 47-year old fe- male patient who underwent excisional biopsy of a lymph node located at right level V complained difficulty with right arm elevation and elbow flexion. She was initially misdiagnosed as right brachial plexus injury. Four months after initial surgery, exploration surgery was conducted. Trans-section of SAN was identified and primary nerve repair (end-to-end anastomosis) was conducted. Two months after nerve repair, shoulder pain decreased signifi- cantly and arm and shoulder movements were improved. Since injury of SAN may have similar clinical features of brachial plexus injury, clinical suspicion and surgical exploration are crucial to prevent such misdiagnosis
Abstract
Spinal accessory nerve (SAN) injury is one of the complications of neck dissection especially for posterior trian- gle lymph node biopsy and results in shoulder dysfunction and chronic pain. Variations in innervation pattern of SAN to the trapezius muscle may lead to a variable clinical presentation from patient to patient and may confuse the diagnosis. Therefore in patients with possible SAN injury, it is important to recognize the clinical symptom and determine whether the patient should have surgical treatment or conservative treatment. A 47-year old fe- male patient who underwent excisional biopsy of a lymph node located at right level V complained difficulty with right arm elevation and elbow flexion. She was initially misdiagnosed as right brachial plexus injury. Four months after initial surgery, exploration surgery was conducted. Trans-section of SAN was identified and primary nerve repair (end-to-end anastomosis) was conducted. Two months after nerve repair, shoulder pain decreased signifi- cantly and arm and shoulder movements were improved. Since injury of SAN may have similar clinical features of brachial plexus injury, clinical suspicion and surgical exploration are crucial to prevent such misdiagnosis
참고문헌 (11)
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