Sonographic evaluation of brachial plexus pathology

Area of Science:

• Radiology and Imaging
• Neurology
• Surgical Anatomy

Background:

• Brachial plexus injuries and pathologies require accurate pre-operative assessment for effective management.
• Conventional imaging modalities may have limitations in visualizing the complex anatomy of the brachial plexus.
• Ultrasound (US) offers a real-time, high-resolution imaging modality for superficial neuroanatomy.

Purpose of the Study:

• To evaluate the efficacy of pre-operative ultrasound (US) in recognizing brachial plexus lesions.
• To define the sonographic morphology, location, extent, and anatomical relationships of these lesions.
• To compare US findings with surgical outcomes and advanced imaging for confirmation.

Main Methods:

• Pre-operative ultrasound examinations of the brachial plexus were conducted on 28 patients with suspected pathology.
• US utilized conventional units (5-10 MHz), with nerves traced from vertebral foramina to the axilla.
• Findings were correlated with surgical results (21 patients) or advanced imaging (e.g., MRI) for non-surgical cases.

Main Results:

• Abnormal US findings were detected in 20 out of 28 patients, identifying traumatic, neoplastic, and inflammatory lesions.
• Specific US findings included nerve disruption, scar tissue, focal masses, and nerve thickening.
• Color Doppler enhanced visualization of vascularity within masses and their relationship to adjacent vessels.

Conclusions:

• Sonography is a valuable tool for pre-operative evaluation of post-ganglionic brachial plexus pathology, providing crucial anatomical and lesion information.
• Mastery of the US technique allows for effective recognition of a spectrum of brachial plexus lesions.
• Limitations include a restricted field of view and difficulty imaging pre-ganglionic segments due to bony structures.