Presentation
60yo female with metastatic breast cancer involving left infraclavicular brachial plexus.
Patient Data
Large mass seen involving the infraclavicular left brachial plexus. The brachial plexus is thickened superiorly to just above the level of clavicle, involving the divisions and cords. It is low T1, high STIR signal. It measures 4.2x2.4x2.6cm (TxAPxcc). The mass avidly enhances. It encases the axillary artery completely and slightly compresses it. It compresses the axillary vein from behind, and infiltration of its wall cannot be excluded. More inferolaterally, lymphadenopathy is seen along mid lateral chest wall at midaxillary line. Multiple prominent lymph nodes also seen along in the neck bilaterally. Moderate canal stenosis at C4/5 and C5/6 from disc osteophyte complexes and flaval thickening.
Conclusion
Large tumor mass involving infraclavicular left brachial plexus.
Case Discussion
The role of MRI in assessing tumors involving the brachial plexus is to 1:
- assess whether nerves are displaced, compressed or infiltrated
- decide whether mass is intrinsic or extrinsic to brachial plexus
- aid in pre-op planning
Tumors can be divided into primary tumors and secondary metastases. They appear as focal or multifocal thickening of a section of the brachial plexus and are usually low intensity on T1-weighted imaging and high intensity on T2-weighted imaging. They typically enhance with contrast. Other evidence of neoplastic disease affecting the brachial plexus includes lymphadenopathy, bony lesions, intrathoracic and chest wall masses. Presence or absence of a tumor may be difficult to ascertain with MRI alone, and a high index of suspicion needs to be applied especially if symptoms such as pain or neurological deficits are present. Further follow-up with repeat MRI, FDG-PET scan or core biopsy may be required 2,3.
Case courtesy of A/Prof Pramit Phal.
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