0:00

So this was a patient that had a right

0:02

shoulder dislocation and then developed

0:05

a severe right brachial plexopathy.

0:08

So, on the coronal T1-weighted image, we can

0:11

see maybe a little bit of abnormal soft tissue

0:14

right here involving the right shoulder joint.

0:17

And when we look at the brachial plexus, we

0:19

can see the subclavian artery here, and right

0:21

above it are the cords of the brachial plexus.

0:25

So, overall, maybe a little bit of thickening

0:28

in the brachial plexus, but maybe not as much

0:31

as one would expect because the patient had a

0:33

severe right brachial plexopathy, and we just

0:36

don't see a lot of anatomic abnormalities.

0:40

When we look at the fat-suppressed T1

0:42

weighted image, now all of a sudden we're

0:44

starting to see a lot of abnormal signal

0:46

right here involving the right shoulder

0:48

joint, which was due to the dislocation.

0:51

And we can see the extent of the soft

0:53

tissue abnormality immediately, and

0:55

it's abutting the brachial plexus.

0:57

So, our subclavian artery is going to be here.

1:00

And then we can see some of the

1:01

cords of the brachial plexus

1:02

surrounding the subclavian artery.

1:05

So this gives us a sense that the surrounding

1:08

hematoma and edema are abutting the cords

1:12

of the brachial plexus because of that

1:14

proximity to the subclavian artery.

1:16

But when we look at the STIR-weighted sequence,

1:19

this really identifies the full extent of the

1:22

abnormality involving the brachial plexus.

1:25

So when we look at the coronal STIR images,

1:27

we can see the edema involving the shoulder

1:29

joint. We can see the joint fluid, but

1:31

more importantly, in the context of this

1:33

lecture, draw a line down the middle and

1:36

compare one side to the opposite side.

1:38

On the left-hand side, we can see the

1:40

subclavian artery and the subclavian vein,

1:42

and we can see the nice stripes, if you will,

1:46

between the brachial plexus, the fat, the

1:48

carotid artery, the fat, and the subclavian vein.

1:51

I like to call those tiger stripes, if

1:53

you will, so we can see the nice stripes.

1:55

But then on the right-hand side, we see

1:57

diffuse soft tissue edema, and it's completely

2:01

involving the cords of the brachial plexus.

2:03

This is our subclavian artery, and we

2:06

can see all of this abnormal signal

2:08

and thickening of the brachial plexus.

2:11

So this is consistent with a very

2:13

severe brachial plexopathy, a brachial

2:15

plexus injury, that arose from

2:18

this very bad shoulder dislocation.

2:21

So unfortunately, if you will, a very nice

2:23

correlation with the patient's symptoms.