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Brachial Plexus

Clinical case and images provided by Avneesh Chhabra, M.D., Johns Hopkins University School of Medicine, Baltimore, USA

Clinical question

27-year-old women with irritable bowel syndrome.

  • Multiple masses found in abdominal CT
  • Interpreted as Neurofibromatosis
  • Referred to Johns Hopkins Neurofirbomatosis clinic for further evaluation
  • Clinically found to have hand weakness bilaterally
  • EMG showed diffuse abnormality suggesting hereditary neuropathy or CIDP
  • Referred for Brachial Plexus MR Neurography for further evaluation

 

Clinical images

Thick Maximum Intensity Projection (MIP) of 3D SPACE
Thick Maximum Intensity Projection (MIP) of 3D SPACE
20 direction MDDW of the brachial plexus with inverted grey scale
Tractography of the 20 direction MDDW scan

Interpretation

  • Diffusely enlarged and hyperintense bilateral brachial plexus segments
  • Symmetrical involvement
  • No abnormal enhancement
  • DTI - Symmetrically low FA values (0.2) and high ADC values - 1.9 and 2.0. Tractography shows mildly disrupted tracts
  • Diagnosis - Charcot Mary Tooth Disease (CMT)

 

Consequences for treatment

  • MR Neurography provided initial diagnosis for abnormality
  • MR Neurography served as pre-intervention road map for biopsy 
  • Final diagnosis - CMT type 1A
  • The diagnosis was proven from subsequent genetic testing and surgical biopsy of a intercostal lesion
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