Bilateral brachial plexopathy. Please assess for inflammation in the right and left brachial plexus. Patient has a remote history of laryngeal cancer and is status post radiation therapy in the early 80s. The study was performed using the cardiac rather than the neurovascular coil due to patient intolerance. This results in incomplete fat saturation, including the postcontrast images, rendering them unreliable.The roots and trunks of the brachial plexi are smoothly thickened and T2 hyperintense bilaterally but more so on the left. More distally, the elements of the brachial plexus on the left may also be thickened though this appearance could also represent scarring from prior surgery. There is no discernible mass on either side of the neck.While this study is not optimally designed to assess the mediastinum, there are multiple mildly enlarged mediastinal lymph nodes. At least a few of them were present on the previous CT scan of the chest from December 11, 2014. Also, there is biapical lung fibrosis/scarring. Partially included wedge-shaped opacity in the posterior lower left lung may be atelectatic.Superior to the tracheostomy entry site, there is thickening involving the left side of the larynx (supraglottic, glottic and subglottic), which may represent posttreatment change. Small lymph nodes in the lower neck are not changed since December 2014 CT examination and may be reactive.There is multilevel degenerative cervical spine disease but without significant spinal canal or foraminal stenosis.There is thickening and sclerosis involving the lateral aspect of the right clavicle with minimal adjacent soft tissue thickening which may relate to previous fracture with adjacent soft tissue involvement. There is central T1-hypointense, T2-hyperintense signal within the medial end of the right clavicle which may reflect marrow necrosis.
1.Non-masslike relatively smooth thickening involving the brachial plexi, left side more than right, is most compatible with radiation fibrosis. 2.Biapical lung fibrosis is likely also related to previous radiation. Mediastinal lymph nodes are present on the previous CT scan from December 2014. These findings are incompletely assessed on this examination.3.Left laryngeal soft tissue thickening without discernible mass is probably posttreatment.4.Right clavicular abnormalities may reflect combination of marrow necrosis and previous fracture.