Female, 51 years old, with history of invasive breast cancer, now with contralateral nodal metastases and left arm paresthesias concerning for nerve impingement. Evaluate nerve involvement in the left neck. Bulky left supraclavicular, level four and level five adenopathy is again seen. In aggregate these lesions measure up to 53 mm CC x 50 mm AP x 32 mm TV. These tumors abut the scalene musculature and almost certainly impinge if not encase the brachial plexus. The adjacent paraspinal musculature is edematous.The left jugular vein is compressed by adjacent adenopathy. The arterial flow voids remain visible compatible with patency. More superiorly in the neck, adenopathy is also demonstrated at the left parotid tail. More distally, small enhancing nodular lesions are evident along the neurovascular bundle leading into the left axilla.Please note that a suspected lesion in the left pons seen on the prior CT is not included within the field-of-view of this examination.
Bulky left supraclavicular adenopathy is seen which almost certainly impinges if not encases the left brachial plexus.