The purpose of this study was to retrospectively evaluate the efficacy of ultrasonography-guided percutaneous ethanol injection (PEI) for neck recurrence of papillary thyroid carcinoma (NR-PTC). Twenty-seven patients (19-80 years old; mean, 53.2) with 47 NR-PTCs were treated by PEI and were followed-up (14-38 months; mean, 28.2). Ethanol (99%) was repeatedly injected with adjusting needle position until the entire volume of NR-PTC was ablated. All patients received follow-up ultrasonography at 3-6-month intervals, and the percent volume decrease was measured. The NR-PTCs with decreased volume and no tumor vascularity on power-Doppler study were regarded as treatment-effective. The NR-PTCs with stable or enlarged volume or with tumor vascularity were considered as treatment-failed, in which case PEI was repeated. The number of sessions and the total volume of ethanol per NR-PTC, and the volume of ethanol per session per NR-PTC were evaluated. All NR-PTCs significantly decreased in volume (range, 30-100%; mean, 93.6%). The mean number of sessions, the total volume of ethanol per NR-PTC, and the mean volume of ethanol per session per NR-PTC were 2.1 sessions (range 1-6), 2.4 ml (range 0.3-10.1), and 1.1 ml/session (range 0.3-3.0), respectively. PEI appears to be an alternative option for controlling NR-PTCs in the selected patients who are poor surgical candidates.