AB133. SOH25_AB_170. Horner’s syndrome after central venous catheter insertion: a case report

Background: Horner’s syndrome has been reported as a rare complication of central venous catheter (CVC) insertion, with an estimated incidence between 1% and 2%. We describe the case of a 19-year-old patient who had a CVC placed for total parenteral nutrition (TPN) administration. The patient had undergone an ileocecal resection and ileostomy on a background of Crohn’s disease and low body mass index (BMI) (12.7 kg/m²).

Case Description: The procedure was explained to the patient and 1 mg of midazolam was administered for anxiolysis. A 16 cm CVC was inserted under sterile conditions and US guidance in the right internal jugular vein using the short-axis-out-plane approach. Lidocaine (1%) was used as local anaesthetic. A chest X-ray post insertion confirmed the correct positioning of the CVC. The patient developed right-sided ptosis and miosis, but denied anhidrosis. The CVC was removed and the ptosis partially improved promptly. The patient was referred to the ophthalmology service who suggested this presentation was likely due to pressure on the sympathetic ganglion post-CVC insertion. A computed tomography (CT) angiogram of the neck was requested which excluded damage to the carotid artery.

Conclusions: Iatrogenic Horner’s syndrome is an uncommon complication of CVC placement which can result from the CVC being in close proximity of the sympathetic chain, despite the use of ultrasound. Better recognition of nearby structures and awareness of presentation of uncommon complications can minimize the risk and enable early diagnosis

Keywords: Catheter; ganglion; Horner’s; case report