Status post liver transplant. Known seroma with inflammation in the region of the left brachial plexus.Additional clinical history from electronic medical records: 63-year-old female with left upper extremity numbness, tingling and weakness. History of orthostatic liver transplant status on 10/5/2015 for hepatitis C/EtOH related cirrhosis with HCC. Diagnosed with CRPS type II of LUE status post liver transplant where her L arm was injured during surgery (swollen 2-3 x normal size). Had L stellate ganglion block in Marc 2016 but with only brief improvement. The surgical incision is again seen along the left upper chest. The underlying T2-hyperintensity in the left pectoris major and minor muscles remains unchanged as well as the mild distortion, probably scarring. The tiny subpectoral collection demonstrates less T2-hyperintensty and is smaller, probably a resolving seroma/hematoma. The adjacent left subclavian vein still shows slight distortion and suggestion of narrowing adjacent to a surgical clip, though looks patent upstream and downstream from this point. There is no asymmetric signal abnormality involving the left brachial plexus. There is no mass along its course but the above-described scarring findings are in the vicinity of the divisions/cords of the plexus. There are small left pectoral lymph nodes.Multilevel degenerative cervical spine disease is not significantly changed since the previous examination, most pronounced at C6-C7 where a disc extrusion with cranial migration is present minimally indenting the left ventrolateral aspect of the spinal cord. Please refer to the report of the previous cervical spine MRI from November 30, 2015 for full details.
1.There is scarring related to the previous left upper chest incision, involving the underlying muscles. There is suggestion of underlying focal stenosis/tethering of the left subclavian vein just adjacent to a surgical clip. Patency of the vein is probably better assessed by Doppler ultrasound, if clinically warranted.2.As discussed previously, though there is no definite injury to the left brachial plexus, the plexus passes reasonably close to the subclavian vein operative field where there is evidence of some scarring and tethering which may have affected the divisions/cords of the plexus. 3.The previously described small subpectoral seroma or hematoma has further regressed.