Brachial plexus root contusion
45yo male motorbike accident. Right clavicle fracture and weakness in right upper limb.
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High resolution 3.0T MRI imaging of the right brachial plexus was performed. The roots, trunks, divisions cords of the right brachial plexus of are intact. Multiple perineural cysts are seen but no evidence of pseudomeningocoeles. There is subtle increased T2 signal along the right C7 nerve root immediately lateral to the exit foramen, and to a lesser extent in the right C6 and C8 nerve roots which may represent contusion. However, nerve roots themselves appear intact. Fractured right clavicle with adjacent oedema within the supraclavicular region is noted.
High-velocity traffic accidents are one of the most common causes of trauma to the brachial plexus. Trauma results in stretching, bruising or tearing of plexus components, post-traumatic meningocoeles, nerve retraction balls, and perineural fibrosis. MRI features of acute brachial plexus injury are described below 1,2:
- affected nerves appear hypointense on T1-weighted and hyperintense on T2-weighted imaging
- swelling, haemorrhage, compression, disruption, displacement and retraction of plexus components
- nerve ruptures seen as discontinuity in the neural structures
- nerve retraction balls on distal end of ruptured nerves
- can have denervation oedema in muscles supplied by the affected nerves
- in the subacute period, fat degeneration and muscular trophism alteration may occur
- direct compression by of the brachial plexus may be visible by haematomas, pseudoaneurysm (especially of subclavian vessels), fracture fragment, callus
Case courtesy of A/Prof Pramit Phal.
- 1. Gerevini S, Mandelli C, Cadioli M et-al. Diagnostic value and surgical implications of the magnetic resonance imaging in the management of adult patients with brachial plexus pathologies. Surg Radiol Anat. 2008;30 (2): 91-101. doi:10.1007/s00276-007-0292-3 - Pubmed citation
- 2. Lawande M, Patkar DP, Pungavkar S. Pictorial essay: Role of magnetic resonance imaging in evaluation of brachial plexus pathologies. Indian J Radiol Imaging. 2012;22 (4): 344-9. doi:10.4103/0971-3026.111489 - Free text at pubmed - Pubmed citation