Journal of Integrative Nephrology and Andrology

CASE REPORT
Year
: 2015  |  Volume : 2  |  Issue : 2  |  Page : 69--70

Vocal Cord Palsy as a Complication of Central Vein Catheterization: A Case Report


Manjunath Kulkarni1, Prashanth Kadri1, Kuldeep Moras2, Nikhil D' Souza1, Maria Bethsaida1,  
1 Department of Nephrology, Father Muller Medical College, Mangalore, Karnataka, India
2 Department of ENT, Father Muller Medical College, Mangalore, Karnataka, India

Correspondence Address:
Manjunath Kulkarni
Associate Professor, Department of Nephrology, Father Muller Medical College, Mangalore - 575 002, Karnataka
India

Abstract

We report a case of a 55-year-old female diabetic patient admitted with uremia. An attempt for insertion of a temporary dialysis into right internal jugular vein was not successful. Next day, the patient developed hoarseness of voice. Indirect laryngoscopy showed that right vocal cord was in paramedian position suggestive of palsy due to injury to recurrent laryngeal nerve. Vocal cord palsy, as a complication of central vein catheterization, is very rare.



How to cite this article:
Kulkarni M, Kadri P, Moras K, D' Souza N, Bethsaida M. Vocal Cord Palsy as a Complication of Central Vein Catheterization: A Case Report.J Integr Nephrol Androl 2015;2:69-70


How to cite this URL:
Kulkarni M, Kadri P, Moras K, D' Souza N, Bethsaida M. Vocal Cord Palsy as a Complication of Central Vein Catheterization: A Case Report. J Integr Nephrol Androl [serial online] 2015 [cited 2019 Oct 17 ];2:69-70
Available from: http://www.journal-ina.com/text.asp?2015/2/2/69/155781


Full Text

 Introduction



Internal jugular vein (IJV) catheterization by a Seldinger technique is a routine procedure in dialysis units. Given the proximity of this vein to carotid artery, pleura, lungs and nerves, there is always a risk of injury to these structures. We report a case of vocal cord palsy caused by injury to recurrent laryngeal nerve (RLN) during IJV catheterization.

 Case Report



A 55-year-old female patient was admitted with complaints of breathlessness and decreased appetite since 15 days. She was a diabetic and hypertensive.She was on insulin and anti-hypertensive drugs. On examination, her blood pressure was 170/100 mmHg. She had pedal edema and facial puffiness. Investigations showed serum creatinine 7.6 mg/dL.

In view of fluid overload and uremia, she was initiated on dialysis. Initial sessions of dialysis were through a femoral dialysis catheter. Later a right internal jugular vein catheterization was attempted. Catheter insertion was not successful as the vein could not be localized. Patient complained of pain and tenderness at the attempted catheter site, but there was no hematoma at the site.

Next day, the patient developed hoarseness of voice. There was no breathing difficulty. Right vocal cord was at paramedian position on indirect laryngoscopy examination which was suggestive of vocal cord palsy due to injury to RLN. The patient was managed expectantly as she did not having breathing difficulty. One week later, a dialysis catheter was inserted in left IJV under Doppler guidance. The patient also underwent a right proximal AV fistula construction.

 Discussion



Vocal cord palsy as a complication of central vein catheterization is rare. Injury to recurrent laryngeal nerve caused vocal cord palsy in this patient. RLN supplies all intrinsic muscles of vocal cord except cricothyroid. Injury to this nerve will cause paralysis of vocal cord and result in dysphonia and hoarseness of voice. We also considered injury to vagus nerve as it also runs close to internal jugular vein. In injury to vagus, vocal cord will be in abducted position and in RLN injury vocal cords will be in paramedian position. RLN injury was diagnosed in this case based on paramedian position of the vocal cord. To the best of our knowledge, only two cases of vocal cord palsy secondary to central vein catheterization have been reported in adults so far. [1],[2] Given to paucity of case reports, we feel that this complication may be relatively rare.

Clinical significance of this condition is that vocal cord palsy must be ruled out in patients having dysphonia after central vein catheterization. If vocal cord palsy is present, one has to be careful in attempting catheter insertion on the other side as bilateral RLN injury is a potentially life threatening condition.

Management of unilateral vocal cord palsy is conservative and complete recovery is usually expected. [3]

Though rare, in case of dysphonia after central vein catheterization in neck vocal cord palsy due to RLN injury should be considered as a differential diagnosis.

References

1Martin-Hirsch DP, Newbegin CJ. Right vocal fold paralysis as a result of central venous catheterization. J Laryngol Otol 1995;109:1107-8.
2Sim DW, Robertson MR. Right vocal cord paralysis after internal jugular vein cannulation. J Laryngol Otol 1989; 103:424.
3Ludlow CL, Mann EA. Neurogenic and functional disorders of the larynx. In: Ballenger JJ, Snow JB, editors. Ballenger's Otorhinolaryngology Head and Neck Surgery. 17 th ed. Spain: BC Decker Inc; 2003. p. 1218-54.