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Brachial Plexus Sonography: A Technique for Assessing the Root Level

Carlo Martinoli1, Stefano Bianchi2, Elena Santacroce1, Francesca Pugliese1, Moshe Graif3 and Lorenzo E. Derchi1

1 Cattedra di Radiologia "R," DICMI, Università di Genova, Largo Rosanna Benzi, 8, I-16132 Genova, Italy.
2 Division de Radiodiagnostic, Hôpital Cantonal Huniversitaire, Rue Micheli du Crest, Geneve, Switzerland.
3 Department of Radiology, The Tel Aviv Ichilov, Sourasky Medical Center, Tel Aviv, Israel.



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  		Fig. 1. —Photograph of cervical spine specimen shows typical appearance of transverse processes, which exhibit prominent anterior (asterisks) and posterior (stars) tubercles. Note absence of anterior tubercle at C7 level and flat lateral aspect of T1 without bony prominence.

 


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  		Fig. 2A. —Phantom containing spine shown in Figure 1. Axial in vitro 5-12—MHz sonogram of C6 vertebra shows two hyperechoic bony processes on its lateral aspect representing anterior (asterisk) and posterior (star) tubercles.

 


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  		Fig. 2B. —Phantom containing spine shown in Figure 1. Axial in vitro 5-12—MHz sonogram of C7 vertebra shows only one process (star) referred to posterior tubercle.

 


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  		Fig. 3. —25-year-old healthy man. Axial 5-12—MHz sonogram reveals relationship of C6 vertebra with soft-tissue structures of lateral neck including thyroid (T), sternocleidomastoid muscle (S), common carotid artery (CCA) and internal jugular vein (IJV). C6 vertebra shows hyperechoic contour, which delineates vertebral body (B), pedicles (P), and anterior (asterisk) and posterior (star) tubercles. C6 root (arrow) appears as hypoechoic image contained between tubercles.

 


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  		Fig. 4A. —Lateral neck of 38-year-old man. Axial 5-12—MHz sonogram at C7 vertebral level shows C7 root (arrow) between vertebral artery (arrowhead) and posterior tubercle (star). Anterior tubercle is absent.

 


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  		Fig. 4C. —Lateral neck of 38-year-old man. Axial 5-12—MHz sonogram at C6 vertebral level reveals C6 root (arrow) and vertebral artery (arrowhead) between anterior (asterisk) and posterior (star) tubercles.

 


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  		Fig. 4B. —Lateral neck of 38-year-old man. CT scan at C7 vertebral level corresponding to A confirms absence of anterior tubercle. Note C7 root (arrow) and vertebral artery (arrowhead) running anterior to posterior tubercle (star).

 


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  		Fig. 4D. —Lateral neck of 38-year-old man. CT scan at C6 vertebral level corresponding to C shows both anterior (asterisk) and posterior (star) tubercles. C6 root (arrow) is located between tubercles.

 

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