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This was a 74-year-old patient that

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presented with left shoulder pain.

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And initially, this patient was treated with

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various injections and then underwent an MR

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of the cervical spine and the brachial plexus.

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So, when we look at her images, on the left

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hand side is a non-contrast T1-weighted image,

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which was performed in the coronal plane.

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And what this demonstrates is a large

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tumor here involving the lung apex.

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Now, if we look at the left hand side, the

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normal anatomy here is that we can see some

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fat right here, right at the lung apex.

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And that represents normal fat

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that is situated right at the lung

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apex at the base of the right neck.

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Right above that is this flow void

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right here, and that flow void right

0:44

there represents the subclavian artery.

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So if you remember the introductory

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lecture, the brachial plexus lives

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right on top of the subclavian artery.

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So these are the cords of the brachial plexus

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that live right on top of the subclavian artery.

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Now, on the patient's left hand side,

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the side of the symptoms, we can see

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that this tumor has extended posteriorly

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and has invaded the left lung apex.

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So we can see that there's no

1:11

fat below the subclavian artery.

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So here's our subclavian artery here.

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We can see that the normal fat in the lung apex

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has been eliminated and replaced by the tumor.

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And notice how this tumor is now narrowing the

1:27

flow void involved in the subclavian artery.

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So when we see this, we know that the

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cords of the brachial plexus are directly

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adjacent to the subclavian artery.

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And anytime that we have a tumor that extends

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superiorly to encase, or surround, or abut,

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or displace the subclavian artery, then

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the brachial plexus has to be involved.

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When we look at the sagittal image,

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this is a sagittal T1-weighted image.

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What we see here are the normal nerve

1:55

roots that are exiting the neural foramen.

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So, I'm just drawing around the normal

1:59

nerve roots here exiting the neural foramen.

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And, in fact, in this image, not only

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can we see the nerve root, but we can see

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the nice fat surrounding that nerve root.

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So, what this tumor has done is that

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it's extended superiorly through the

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lung apex into the base of the left

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supraclavicular fossa, as is seen here.

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And, unfortunately, this tumor is

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surrounding and encasing the nerve roots.

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So we can see the involved nerve roots on

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the left-hand side compared to the normal

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nerve roots which I've circled above.

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So this is an example of a patient

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that has a left Pancoast tumor.

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Sometimes it's called a

2:35

superior sulcus tumor.

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I'm not sure how often that term is used.

2:39

But it is extending into the lung apex.

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We know that there has to be

2:43

brachial plexus involvement.

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Why?

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Because it's encasing the nerve roots.

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That brachial plexus and that secondary

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finding, it's also involved and obliterated

2:53

the fat involving the left lung apex.

2:56

So those are the findings that

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tell you that there's brachial

2:59

plexus involvement in this case.