Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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April 6, 2015
Brachial Plexitis
- Inflammatory brachial plexopathies are relatively uncommon, and when they are found, most are secondary to the effects of prior therapeutic irradiation. Other causes of brachial plexitis are idiopathic (Parsonage-Turner syndrome); viral (cytomegalovirus, Coxsackie, herpes zoster, Epstein-Barr virus, Parvovirus B19); immune-mediated or toxic (related to previous serum, vaccine, antibiotic, or other drug administration); and Lyme disease. Brachial plexitis is more commonly seen in men between 30 and 70 years old, and is bilateral in 10%–30% of patients.
- Key Diagnostic Features: MR imaging findings ranging from normal-to-mild thickening of the brachial plexus and hyperintensity on T2WI and STIR images, with/without enhancement. Denervation signal-intensity changes appear in the muscles of the shoulder girdle and chest in subacute and chronic phases of brachial plexitis.
- DDx:
- Radiation plexopathy
- Traumatic injury
- Metastasis
- Schwannoma
- Rx: Depending on the severity of the individual’s symptoms, treatment for brachial plexitis will often be two-fold: 1) an initial focus on controlling the pain, and; 2) a longer-term focus on nerve healing and rehabilitation.
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