Presentation
60yo male with right-sided Pancoast tumor previously treated with radiotherapy.
Patient Data
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 visualized 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 tumor. A PET scan may help differentiate.
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 tumors 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 tumor recurrence 1,2.
Case courtesy of A/Prof Pramit Phal
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