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Imaging the Anatomy of the Brachial Plexus: Review and Self-Assessment Module*

Mauricio Castillo1

1 Department of Radiology, University of North Carolina School of Medicine, Campus Box 7510, Chapel Hill, NC 27599-7510.



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  		Fig. 1 —Avulsion injuries in 26-year-old man with weakness and pain in upper extremity after motorcycle crash. Coronal fat-suppressed T2-weighted image shows bright fluidfilled pseudomeningoceles (arrows) in course of C8 and T1 nerve roots.

 


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  		Fig. 2A —Avulsion injuries in 26-year-old man. Coronal postgadolinium T1-weighted image (A) and parasagittal T2-weighted image (B) show posttraumatic pseudomeningoceles (arrows) involving C7 and C8 nerve roots.

 


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  		Fig. 2B —Avulsion injuries in 26-year-old man. Coronal postgadolinium T1-weighted image (A) and parasagittal T2-weighted image (B) show posttraumatic pseudomeningoceles (arrows) involving C7 and C8 nerve roots.

 


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  		Fig. 3 —Stretching ("burning") injury of right brachial plexus in 35-year-old man. Coronal fat-suppressed T2-weighted image shows that there is high signal, indicating edema, and thickening of divisions and cords (straight arrows) of right brachial plexus. Note effusion (curved arrow) in ipsilateral shoulder joint due to traction injury of upper extremity.

 


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  		Fig. 4 —Diagram illustrates basic anatomy of brachial plexus. Brachial plexus is formed by anterior rami of C5-T1 nerve roots. Roots are located in neural foramina and trunks between scalene muscles. Divisions are posterior to clavicle, and cords are inferior to it. LC = lateral cord, PC = posterior cord, MC = middle cord. (Reprinted with permission from Royal College of Radiologists [10])

 


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  		Fig. 5 —65-year-old man presenting with left-sided mixed (i.e., motor and sensory) brachial plexopathy of 2 months' duration. Patient also has history of cigarette smoking and persistent cough that developed 3 weeks earlier. Chest radiography (not shown) revealed abnormal findings. Coronal T1-weighted image shows large left tumor (arrow); note normal interscalene fat pad on right. Obliteration of this fat by tumor as seen here generally implies invasion of brachial plexus at level of trunks that normally course between scalene muscles in interscalene fat pad.

 


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  		Fig. 6 —Small left Pancoast's tumor in 60-year-old woman. Coronal T1-weighted image shows small bilobed mass (white arrow) in left lung apex. Note preservation of normal interscalene fat pad (black arrow), which on coronal images has triangular appearance. Left brachial plexus (arrowhead) is nicely seen.

 


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  		Fig. 7 —Schwannoma in 45-year-old woman. Coronal fat-suppressed T2-weighted image shows mass with high signal intensity (lower arrow) in region of roots and trunks of right brachial plexus. Note "tail" of mass extending into C7-T1 right neural foramen (upper arrows). This finding is typical of nerve sheath tumors.

 


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  		Fig. 8 —Metastases from breast carcinoma in 58-year-old woman. Coronal fat-suppressed T2-weighted image shows two masses (large arrows) that are inseparable from underlying right brachial plexus. Divisions and cords of brachial plexus (small arrow) adjacent to tumors are bright and swollen.

 


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  		Fig. 9A —Lipoma in 44-year-old woman. Coronal T1-weighted image (A) and corresponding fat-suppressed image (B) show well-defined fatty mass (arrows) that typically loses all signal intensity after fat-suppression technique is applied.

 


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  		Fig. 9B —Lipoma in 44-year-old woman. Coronal T1-weighted image (A) and corresponding fat-suppressed image (B) show well-defined fatty mass (arrows) that typically loses all signal intensity after fat-suppression technique is applied.

 


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  		Fig. 10A —Traumatic pseudoaneurysm in subclavian artery of 38-year-old man. Coronal unenhanced (A) and axial enhanced (B) T2-weighted images show mass (arrows) in region of right subclavian artery compressing brachial plexus. Note concentric rings of varying signal intensities due to clot that forms walls of this pseudoaneurysm.

 


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  		Fig. 10B —Traumatic pseudoaneurysm in subclavian artery of 38-year-old man. Coronal unenhanced (A) and axial enhanced (B) T2-weighted images show mass (arrows) in region of right subclavian artery compressing brachial plexus. Note concentric rings of varying signal intensities due to clot that forms walls of this pseudoaneurysm.

 


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  		Fig. 11 —57-year-old woman who had undergone surgery and irradiation for treatment of left-sided breast carcinoma and was doing well until about 7 months after termination of radiation therapy, when she developed weakness and pain in left upper extremity. Coronal fat-suppressed T2-weighted image shows diffuse thickening and increased signal intensity (arrow) in region of left brachial plexus affecting trunks, divisions, and cords.

 


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  		Fig. 12 —Coronal fat-suppressed T2-weighted image shows mild thickening and increased signal in trunks for left brachial plexus in 45-year-old man who presented with sudden onset of weakness in ipsilateral upper extremity. Symptoms resolved spontaneously 4 weeks later; this case was assumed to be a virus-induced plexopathy.

 


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  		Fig. 13 —Charcot-Marie-Tooth disease in 18-year-old woman. Coronal fat-suppressed T2-weighted image shows left brachial plexus to be thick and hyperintense.

 

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