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Pulmonary scarring/collapse in the posteromedial aspect of the lung apex is associated with oedema and intramuscular enhancement in the adjacent intercostal and scalene musculature and also within serratus posterior, likely to be secondary to radiation change. Similar appearances in the right apex were identified on a CT chest from September 2013. T1 hypointense soft tissue thickening partially surrounds the brachial plexus most pronounced where it crosses the first rib. This appears to draw-in and distort the lower trunk and to a lesser extent the middle trunk of the brachial plexus, and also involves the medial and probably posterior cords. This is associated with mildly asymmetric thickening of the C8 and T1 nerve roots.
Distortion of the lower trunk and medial cords and to a lesser extent middle trunk and posterior cord of the right brachial plexus by abnormal soft tissue at the thoracic outlet. The similarity of right apical lung change to a CT from 2013 and the morphology of the brachial plexus abnormality ( drawn in rather than enveloped ) would be more compatible with radiation plexopathy than tumour infiltration.
Report courtesy of Royal Melbourne Hospital Radiology Department