Presentation
Asymptomatic, firm right neck mass for 2 years. No symptoms in the right upper extremity.
Patient Data
Enhancing mass in the right supraclavicular region between the anterior scalene muscle and middle scalene muscle with internal areas of low density.
An oval circumscribed lesion in the right supraclavicular region, located in the scalene triangle between the anterior scalene muscle and middle scalene muscle. This appears as T1 hyperintense (relative to skeletal muscle) and T2/STIR hyperintense. Enhancement is difficult to assess due to failure of fat saturation and artifactual signal. This lesion appears to arise from the distal right C5 nerve root with compression of the adjacent C6 nerve root or may arise from the superior trunk of the brachial plexus at the C5 and C6 nerve root junction.
Pathology from surgical resection of the right brachial plexus mass was consistent with a schwannoma.
Case Discussion
This patient underwent surgical resection of the schwannoma without any complications. During the operation, the schwannoma was seen to involve the right C5 nerve root and superior trunk, as seen on the MRI.
Schwannomas are slow-growing, peripheral nerve sheath tumours that originate from Schwann cells in peripheral, cranial, or autonomic nerves 1. Approximately 25-45% occur in the head and neck region 2,3. It can be difficult to distinguish schwannoma from neurofibroma on imaging. Definitive diagnosis is made via histologic assessment 2.
Schwannomas of the brachial plexus present a particular challenge due to the neuroanatomic complexity of the area 4. Although they are surgically curable with generally favourable outcomes, it is important to carefully weigh the risks and benefits on a case-by-case basis, especially in asymptomatic patients 4.
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