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Difficulty: MediumCardiothoracic and Vascular Surgery

Match each postoperative clinical presentation to the anatomical structure most likely injured during the cardiothoracic procedure.

  • Hoarseness and left vocal cord paralysis after repair of a distal aortic arch aneurysmLeft recurrent laryngeal nerve
  • Ipsilateral ptosis, miosis, and anhidrosis following surgical resection of an apical lung tumorSympathetic chain
  • Drainage of opaque, milky pleural fluid rich in triglycerides on postoperative day 3 following esophagectomyThoracic duct
  • Paradoxical upward movement of the right hemidiaphragm during inspiration after a right pneumonectomyPhrenic nerve

Answer

The correct matches correlate each iatrogenic clinical syndrome with its respective anatomical structure: hoarseness to the left recurrent laryngeal nerve, Horner syndrome to the sympathetic chain, chylothorax to the thoracic duct, and diaphragmatic paralysis to the phrenic nerve.
Each matching pair represents a classic iatrogenic injury in cardiothoracic surgery governed by regional anatomy. The left recurrent laryngeal nerve is vulnerable during aortic arch surgery, leading to hoarseness. The sympathetic chain (stellate ganglion) is vulnerable during apical lung resections, leading to Horner syndrome. The thoracic duct is at risk during esophageal surgery, causing a chylothorax. The phrenic nerve is at risk during hilar dissections, causing diaphragmatic paralysis.

Step-by-Step Solution

1
Analyze the vocal cord paralysis presentation.
Matches to the left recurrent laryngeal nerve.
The anatomical course of the left recurrent laryngeal nerve makes it vulnerable during aortic arch interventions.
2
Analyze the ptosis, miosis, and anhidrosis presentation.
Matches to the sympathetic chain.
These are the classic signs of Horner syndrome, caused by disruption of the sympathetic ganglion at the lung apex (e.g., Pancoast tumor resection).
3
Analyze the milky, high-triglyceride pleural effusion presentation.
Matches to the thoracic duct.
This presentation describes a chylothorax, commonly caused by injury to the thoracic duct during esophageal surgery.
4
Analyze the paradoxical hemidiaphragm movement presentation.
Matches to the phrenic nerve.
The phrenic nerve provides motor innervation to the diaphragm and is at risk during hilar dissections such as a pneumonectomy.

Key Concept

Iatrogenic anatomic injuries in cardiothoracic surgery
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Topics

Cardiothoracic and Vascular Surgery

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