Vocal Fold Paralysis Secondary to Subclavian Venous Thrombosis

Unilateral vocal fold paralysis as a port complication

“…In the present case, the UVFP does not seem to have been caused by direct trauma of the vagus or laryngeal recurrent nerves during port placement, considering the late onset of dysphonia regarding the procedure itself. One possible cause of the vocal palsy in this patient might be related to a venous thrombosis (in this case the left innominate and subclavian veins), as described by Hervé et al 8 and Hamdan and Dabbous, 9 with eventual inflammatory process and fibrosis around the nerve that led to the loss of nerve function, 11 as described by Keidan 10 This is suggested by a densification of the soft tissues anteriorly to the supra-aortic trunks in the thorax CT scan (Figure 2), particularly in the area lateral to the left carotid artery, between the subclavian vein and artery where it is expected the vagus or laryngeal recurrent nerves to be found. 5 Although rarely described, in cancer patients venous thrombosis of the great vessels of the head and neck can happen spontaneously and associated to UVFP, in the sequence of a hypercoagulability state.…”

“…7 In the case reported by Hervé et al the tip of the catheter placed in the subclavian vein migrated to the IJV and resulted in thrombosis and drug extravasation (in this case 5FU) through the vessel, which caused an UVFP that persisted for at least 4 months. 8 Recently, Hamdan and Dabbous 9 described one case of irreversible UVFP secondary to a subclavian vein thrombosis but in this case it was contralateral to the side of the port placement. Keidan 10 had previously reported three cases of recurrent nerve palsy caused by deep venous thrombophlebitis and associated mediastinal inflammation (all three patients with an indwelling permanent catheter).…”

“…In this particular case report, considering the patient’s oncologic disease, the possibility of a metastasis or a secondary tumor in the neck or thorax must be considered and it was excluded through the physical examination, endoscopic examination and imaging. Moreover, a viral etiology for the UVFP could not be completely excluded, as noted by Hamdan and Dabbous, 9 although the authors considered the totally implantable venous-access port as the most probable cause (with or without drug extravasation).…”