Pancoast tumour treated with radiotherapy

Case contributed by Dr Shu Su

Presentation

60yo male with right-sided Pancoast tumour previously treated with radiotherapy.

Patient Data

Age: 60
Gender: Male
Modality: MRI

In the right supraclavicular fossa, in an extrapleural location, there is a triangular area of enhancing tissue measuring up 14.8 x 25.4 x 17.3 mm. This engulfs the right C8 and T1 nerve roots and the lower cord of the brachial plexus. Small amount of posterior disc-osteophyte complex seen at C5/6 and C6/7 which indents the ventral cord without causing cord signal abnormality.

Conclusion: There is a lesion visualised that would account for the patient's clinical presentation, namely a triangular area of enhancing tissue in the right supraclavicular fossa engulfing the right C8 and T1 nerve roots.  It is uncertain if this represents radiation fibrosis or recurrent tumour.  A PET scan may help differentiate.

Modality: Annotated image

In the right supraclavicular fossa, in an extrapleural location, there is a triangular area of enhancing tissue measuring up 14.8 x 25.4 x 17.3 mm. This engulfs the right C8 and T1 nerve roots and the lower cord of the brachial plexus. 

Case Discussion

Radiation is the most common cause of non-traumatic brachial plexopathy and much of this is iatrogenic, for example following radiotherapy for cancer. Symptoms may be delayed for months to years with peak onset being 10-20months. MRI can be used to distinguish brachial plexopathy due to radiation as opposed to incidence or recurrence of a mass. Unfortunately, both tumours and radiation plexopathy can exhibit hypointensity on T1-weighted imaging and hyperintensity on T2-weighted imaging as well as enhancement following gadolinium contrast; the most reliable sign is the detection of a visible mass in the case of tumour recurrence 1,2.

Case courtesy of A/Prof Pramit Phal

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Case Information

rID: 31968
Case created: 8th Nov 2014
Last edited: 3rd Oct 2015
Inclusion in quiz mode: Included

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