Cervical lymphadenopathy - gastric adenocarcinoma (CT cervical spine)

Case contributed by Henry Knipe

Presentation

Neck pain with radiculopathy.

Patient Data

Age: 70 years
Gender: Male

Mild retrolisthesis of C3 on C4. Degenerative remodeling of the C4 and C5 vertebral bodies. Loss intervertebral disc space at C3-4 to C5-6. Multilevel facet joint arthropathy. Pleural scarring in both lung apices.

Large abnormal soft tissue mass in the right neck measuring at least 10 cm extending into the upper thorax along the right aspect of the trachea. No left-sided cervical lymphadenopathy. Right carotid arteries are displaced anteriorly.

No distinct bony destruction/erosion or focally aggressive lesion.

Case Discussion

The large mass subsequently turned out to be conglomerate lymphadenopathy extending from the right paratracheal stations into the cervical chain. The patient had a subsequent diagnosis of gastric adenocarcinoma.

Presumably, the patient's radiculopathy was secondary to brachial plexus invasion, and this case is a good reminder (and an example of gross pathology) to always assess the extravertebral structures on degenerative spine imaging.

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