Transient Pourfour du Petit Syndrome

Abstract

To the Editor: Sulemanji et al. (1) recently reported a case of transient Horner’s syndrome after insertion of a subclavian venous catheter in a 3-yr-old. We recently observed a rare case of transient Pourfour du Petit syndrome, after internal jugular catheter insertion in a 17-mo-old male patient. Pourfour Du Petit, a 19th century French physician, first described the signs of cervical sympathetic hyperactivity in soldiers with stab wounds to the neck (2). The syndrome is classically described as mydriasis, exophthalmoses, and pale cool skin which are opposite to the symptoms described by Horner. Pourfour du Petit syndrome has been observed secondary to trauma and mass effect from tumors (3,4) but never after central venous catheterization. A 17-mo-old previously healthy male underwent exploratory laparotomy for bowel perforation secondary to intussusception. The surgery was uneventful and the surgeon requested a central venous catheter be inserted before tracheal extubation for administration of antibiotics. We used external landmarks to attempt the catheterization on the right internal jugular vein. On the first attempt, we were unsuccessful at aspirating blood. Our second attempt was at a spot just inferior and medial to the first and we successfully inserted a central venous catheter using Seldinger’s technique. We did not encounter any complications during catheter insertion. After an uneventful tracheal extubation, we observed that his right pupil was dilated in comparison to the left pupil (3 mm/2 mm); however, light reflex and accommodation remained intact. The patient’s right face and right upper extremity appeared mottled and cold compared with the left side. However, the right carotid and radial pulses remained intact and equal in strength compared to the left side. The combined symptoms led us to the diagnosis of Pourfour du Petit syndrome accompanied by hyperstimulation of the brachial plexus sympathetic chain. The patient’s symptoms regressed over the next 24 h and by discharge 5 d later, his symptoms had completely resolved. Jesse Aron, MD Debnath Chatterjee, MD Department of Anesthesiology Upstate University Hospital Syracuse, NY [email protected]