• Ji Eun Shin, Jung Hwan Baek, Eun Ju Ha, Young Jun Choi, Woo Jung Choi, and Jeong Hyun Lee.
• †Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine *Department of Radiology, CHA University College of Medicine, Gangnam CHA Hospital, Seoul ‡Department of Radiology, Ajou University School of Medicine, Suwon, Korea.
• Clin J Pain. 2015 Oct 1; 31 (10): 909-13.

ObjectivesTo evaluate the feasibility of ultrasound (US) detection of the middle cervical sympathetic ganglion (CSG).Materials And MethodsWe examined 52 consecutive patients with 104 bilateral middle CSGs. We identified middle CSG according to our sonographic assessment criteria. After finding oval-shaped hypoechoic structure on transverse scan, we verified a continuous, hypoechoic line connecting the bulbous structure at both sides. The basic US characteristics were evaluated using the size, location, relationship to the common carotid artery, and relationship to the inferior thyroidal artery.ResultsThe middle CSG was identified in 41% (43/104). The mean size of the middle CSG was 3.8±1.5 mm in width, 1.9±0.7 mm in height, and 8.7±3.2 mm in length. They were primarily located at the C6 level (41/43, 95%). Regarding the relationship with common carotid artery, 88% (38/43) were lateral type and 12% (5/43) were medial type. Regarding the relationship with the inferior thyroid artery, 34% (15/43) were anterior type, 26% (11/43) were posterior type, and 40% (17/43) were unable to access the relationship.DiscussionDirect visualization of middle CSG based on the understanding of both its location and US features may reduce complications and improve the accuracy of US-guided neck procedures.

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