Schwannoma: brachial plexus

Case contributed by John Doe

Presentation

Firm, non-tender mass on right lateral neck, above clavicle.

Patient Data

Age: 25
Gender: Female
Modality: Ultrasound

Ultrasound reveals a hypoechoic ovoid mass, measuring 1.8 x 1.2 x 2.9 cm.  Patient was referred for neck CT.

Modality: CT

Mass appears as asymmetric musculature without abnormal enhancement on post-contrast CT (marked with an X).

Patient returned two years later because mass had grown.  Tensing or extending the right arm or pushing on the mass produced pain in the knuckles of the right index and middle fingers.

Modality: MRI

MRI shows a well circumscribed mass contiguous with the right C7 nerve measuring 2.7 x 4 x 2.5 cm.  It appears T1 isointense and slightly T2 hyperintense with homogeneous contrast enhancement.

The patient mentioned having a stripe of numbness along a rib on the right side for at least seven years and was found to have hyperactive reflexes.  These symptoms indicated an MRI of the thoracic spine.

Modality: MRI

MRI finds a large right paravertebral mass demonstrating heterogeneous T2 signal with solid and cystic change and heterogeneous enhancement.  It measures 9.8 x 7.5 x 7.3 cm and appears to arise from the right T8-T9 neural foramen.  It is similar to the first tumor, which is also visible.

Modality: CT

The chest tumor is retrospectively found in the neck CT scout view.

Modality: CT

CT for surgical planning reveals scattered calcifications within the mass and is otherwise consistent with previous MRI findings.

Additional MRIs of the lumbar spine and brain found nothing.

The first mass was surgically removed from the surrounding nerve fibers without impairing strength or sensation.  It was found to be a benign schwannoma.

Modality: Pathology

Brachial plexus schwannoma.

The second mass was removed with a partially muscle-sparing posterolateral thoracotomy at the sixth intercostal space, along with the associated T8 nerve.  It was also a benign schwannoma.

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Case Information

rID: 30213
Case created: 25th Jul 2014
Last edited: 8th May 2017
Systems: Head & Neck, Chest
Inclusion in quiz mode: Included

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