Newly Published
Images in Anesthesiology  |   January 2020
Cervical Lymphadenopathy Masquerading as the Interscalene View of the Brachial Plexus
Author Notes
  • From the Department of Anesthesiology, University of California San Diego, San Diego, California.
  • Correspondence: Address correspondence to Dr. Regnier: sregnier@ucsd.edu
Article Information
Images in Anesthesiology / Central and Peripheral Nervous Systems
Images in Anesthesiology   |   January 2020
Cervical Lymphadenopathy Masquerading as the Interscalene View of the Brachial Plexus
Anesthesiology Newly Published on January 27, 2020. doi:https://doi.org/10.1097/ALN.0000000000003141
Anesthesiology Newly Published on January 27, 2020. doi:https://doi.org/10.1097/ALN.0000000000003141
Interscalene block of the brachial plexus is useful for analgesia after surgery on the distal clavicle, shoulder, and upper arm. When performing an interscalene block with ultrasound guidance, anesthesiologists identify the prototypical stoplight appearance of the C5, C6, and C7 nerve roots (solid arrows) between the scalene muscles (panel A).1  Although this view is often easily obtained, patient anatomy can be deceiving, particularly in individuals with cervical lymphadenopathy. During interscalene block in a patient with significant cervical lymphadenopathy, three hypoechoic structures (dashed arrows, panel B) were seen with similar ultrasonographic appearance to the interscalene view of the brachial plexus; these structures were later identified as enlarged lymph nodes. Also visible in both panels are the carotid artery and sternocleidomastoid muscle.