A Case of Mistaken Identity: Doubled Superior Cervical Ganglia

The sympathetic chain serves as a major hub for distribution of both sensory and motor innervation of smooth muscle, cardiac muscle and glands throughout the entire body. The sympathetic chain, along its course from the base of the skull to the tip of the coccyx, includes numerous ganglia that house cell bodies of postsynaptic neurons. The cervical portion of the sympathetic chain includes superior, middle, inferior/stellate and vertebral ganglia. As a group, these ganglia are subject to significant anatomical variation in their location and even presence. While the superior cervical ganglion appears to be the most consistent of these ganglia, there remains a discrepancy in the literature. Specifically, the superior cervical ganglion has been reported to be doubled but this appears to have been perpetuated without clear documentation. This discrepancy was brought to our attention during a detailed dissection of the retropharyngeal region that exposed the superior cervical ganglion and structures at the skull base, including what appeared to be a ganglion anterior to the carotid sheath. This dissection matched exactly the earliest report of a doubled superior cervical ganglion. However, histological examination revealed the mass anterior to the carotid sheath to be a retropharyngeal lymph node. Based on this finding, consistent with large-scale studies of the cervical sympathetic chain, we posit the original observation was of a lymph node and not a doubled superior cervical ganglion.