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Iatrogenic Horner syndrome after tube thoracostomy

Robert Baird1, Zainab Al-Balushi, Jeff Wackett

  • 1Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada. robert.baird@mail.mcgill.ca

Journal of Pediatric Surgery
|October 27, 2009
PubMed

Insights

Iatrogenic Horner syndrome, a rare complication of chest tube insertion, can occur in children. Symptoms like ptosis and miosis resolved after chest tube removal, highlighting potential sympathetic chain injury.

Area of Science:

  • Pediatric Surgery
  • Neurology
  • Ophthalmology

Background:

  • Chest tube insertion (tube thoracostomy) is a common procedure for pediatric pleural effusions and pneumonia.
  • Iatrogenic Horner syndrome is an uncommon but documented complication of thoracic procedures.
  • Limited pediatric literature exists on this specific complication.

Observation:

  • A 13-month-old boy developed left-sided ptosis, miosis, and anhydrosis post-chest tube insertion for pneumonia.
  • Clinical improvement in respiratory and septic parameters was noted.
  • Neurological symptoms resolved spontaneously after chest tube removal.

Findings:

  • The case illustrates a potential iatrogenic injury to the ipsilateral sympathetic chain during chest tube placement.
  • This complication, though rare, should be recognized in pediatric patients undergoing thoracic procedures.
  • Resolution of symptoms post-removal supports the link to the chest tube.

Implications:

  • Awareness of this complication is crucial for pediatric surgeons and intensivists.
  • Careful technique during chest tube insertion may minimize risk to the sympathetic chain.
  • Further research into pediatric sympathetic chain injury during thoracic procedures is warranted.

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