Iatrogenic injury of the spinal accessory nerve
Second recurrence of lymphoma. Neck node biopsy about 2 months back followed by complaining of left shoulder pain. Referred for the ultrasound of spinal accessory nerve.
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The spinal accessory nerve is traced from anterior-cranial to posterior-caudal aspect of the left side of neck; starting deep to sternocleidomastoid (labeled as SCM in images ) and passing deep to trapezius muscle. There is hypoechoic thickening with loss of nerve fiber continuity involving about 7 mm long segment of nerve at surgical scar region. Continuity of the deeper nerve fibers is possibly maintained. There is no local collection. Short axis images are labeled as 1 to 8 from cranial to caudal aspect.
A female presented with history of second recurrence of lymphoma. The patient had neck lymph node biopsy about 4 years back and it was uneventful. However, she developed left shoulder related complaints after recent left-sided neck node biopsy about 2 months ago.
The spinal accessory nerve runs deep to sternocleidomastoid and passes deep to trapezius, with a segment of a nerve between muscles lying in the subcutaneous plane where it is at risk of injury during a lymph node biopsy.
Ultrasound showed two adjacent scars related to lymph node biopsy. First biopsy scar was not involving / abutting nerve. However, the second biopsy scar shows an involvement of the nerve which favors iatrogenic injury to the nerve.
- Ultrasonography of the Accessory Nerve Normal and Pathologic Findings in Cadavers and Patients With Iatrogenic Accessory Nerve Palsy Gerd Bodner MD and others. https://doi.org/10.7863/jum.2002.21.10.1159
- Role of Sonography in Surgical Decision Making for Iatrogenic Spinal Accessory Nerve Injuries: A Paradigm Shift. Cesmebasi A1, Smith J1, Spinner RJ2. J Ultrasound Med. 2015 Dec;34(12):2305-12. doi: 10.7863/ultra.15.01049. Epub 2015 Nov 5.