Female, 70 years old, history of left neck sarcoma, with left vocal cord paralysis and left eye ptosis. Assess entire left recurrent laryngeal nerve. Findings are seen related to extensive surgical alteration in the left supraclavicular region. Superficial nodular tumors seen in this area on the prior examination (2/14/12) have been resected with soft tissue grafting. The left sternocleidomastoid muscle is atrophic. The left paraspinal musculature are also somewhat atrophic along with the left trapezius.The soft tissues along the left brachial plexus are diffusely thickened showing abnormal T2 hyperintensity and fairly marked pathologic enhancement. These abnormal findings extend from the level of the roots distally to at least the level of the cords but probably beyond. Although the individual neural components of the brachial plexus are not well visualized as distinct structures, it is possible that at least some of these nerves are irregularly thickened. These findings are much progressed when compared to the prior examination from 2012.Areas of abnormal signal intensity and marked enhancement are found more distally distally involving the musculature of the left shoulder girdle. Subtle ill-defined T2 hyperintensity also extends anteriorly and superiorly along the carotid space where there are several small but enhancing nodules.The visualized mucosal surfaces of the aerodigestive tract are otherwise unremarkable. The salivary glands are free of lesions. The marrow signal characteristics are unremarkable. No spinal canal stenosis is suspected. No mediastinal masses are detected on this examination.
Marked abnormal signal and pathologic enhancement with diffuse soft tissue thickening is evident along the left brachial plexus. The neural elements of the brachial plexus are not well visualized individually, but at least some of these nerves could be significantly and irregularly thickened. Areas of similar signal abnormality and pathologic enhancement are seen within the soft tissues of the left shoulder girdle, as well as extending superiorly along the carotid space where there are small but enhancing nodular lesions.Given the bulky nature of the findings along the left brachial plexus, and extension into several adjacent shoulder and neck spaces, the possibility of infiltrative tumor should be considered. An aggressive radiation-induced brachial plexitis could produce some of these findings, but this would be a diagnosis of exclusion.