63-year-old female with left upper extremity numbness tingling and weakness. Evaluate for abnormalities. History of orthostatic liver transplant status post HCC with recent Histiocytosis X. Cervical Spine:The craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. The alignment is maintained. The bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is mild uncovertebral and facet hypertrophy which causes mild bilateral neural foraminal stenosis but no central canal stenosis.C4-5: There is a small disc osteophyte complex and mild facet hypertrophy causing mild-to-moderate left neuroforaminal stenosis but no right neural foraminal or central canal stenosis.C5-6: There is a small disc osteophyte complex with a process extending along the ventral spinal canal from the C5-6 to the C6-7 level representing either posterior longitudinal ligament thickening or disc material. There is also facet hypertrophy and ligamentum flavum thickening. This results in effacement of the ventral thecal sac and mild central spinal canal stenosis. No evidence of neural foraminal stenosis.C6-7: There is a left greater than right paracentral disc protrusion. As described above there is posterior longitudinal ligament thickening or disc material appearing in continuation with the more superior level. There is also uncovertebral and facet hypertrophy as well as ligamentum flavum thickening. This causes mild left neural foraminal stenosis and flattening of the ventral spinal cord at this level. There is no right neuroforaminal stenosis.C7-T1: There is a disc osteophyte complex, facet and uncovertebral hypertrophy as well as ligamentum flavum thickening. However there is no neural foraminal or central spinal canal stenosis.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Brachial Plexus:There is evidence of a surgical incision along the left upper chest wall likely from access of the subclavian vein during the transplant procedure. Again seen is a subpectoral collection which is decreased significantly in size compared to the prior CT from November 9th. Along the subclavian vein is evidence of some inflammation and probably at least one surgical clip. Mild increased T2 signal parallels the left subclavian vein and its proximal tributaries suggesting edema or inflammation. In addition, central nonenhancement of the vein and its tributaries is noted which raises the question of possible subclavian vein thrombosis. No obvious injury to the nerves of the brachial plexus is seen allowing for motion degredation. However the nerves of the plexus pass in some proximity to the subclavian operative bed and may be affected by the above described edema and inflammation.
1.Mild degenerative changes of the cervical spine most prominent at the C6-7 level where there is a left greater than right paracentral disc protrusion which causes some flattening of the left ventral aspect of the spinal cord as well as mild left neural foraminal stenosis.2.Although 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 persistent edema and inflammation which may have affected these nerves to some degree. A previously seen subpectoral seroma or hematoma has significantly decreased in size.3.Inflammation of the left subclavian vein and its tributaries is suspected with possible thrombosis. Ultrasound may be helpful to evaluate the possibility of thrombosis if clinically warranted.