MR imaging targeted to the left brachial plexus performed including post gadolinium sequences. Correlation made with the CT examination. A 5.4 x 3.2 x 3.8 cm (trans x AP x CC) left apical peripherally enhancing soft tissue mass with invasion of the first and second ribs, involvement of the pedicle, transverse process, posterior elements and the posterolateral aspect of the T2 vertebral body and invasion of the posterior paravertebral musculature consistent with the history of Pancoast's tumour.
Abnormal marrow signal within the left lateral aspect of C7 and T1 vertebrae. No epidural soft tissue extension. The abnormal enhancing soft tissue extends through the intercostal musculature superiorly to the supraclavicular compartment with diffuse infiltration of the supraclavicular compartment in addition to supraclavicular lymphadenopathy. The cords and trunks of the left brachial plexus course through the abnormal enhancing soft tissue and are directly involved by the tumour. In addition the posterior divisions and cords demonstrate abnormal enhancement and thickening consistent with tumour infiltration. The abnormal soft tissue does not encased the subclavian vasculature.
CONCLUSION: Locally invasive left Pancoast tumour with destruction of the first and second ribs, invasion of supraclavicular fossa with direct involvement of the cords, trunks and posterior divisions of the left brachial plexus, C7, T1 and T2 vertebrae and paravertebral musculature.