Radiographic evaluation of brachial plexopathy

Neurologic signs and symptoms of brachial plexopathy may be subtle or confusing, making clinical localization of disease along the length of the brachial plexus difficult. To determine the most direct radiographic approach to diagnosing and anatomically delineating the cause of brachial plexopathy, we reviewed the clinical and radiographic records of 43 patients presenting with signs and symptoms referable to the brachial plexus who received CT and/or myelography as part of their radiographic evaluation. The study population was divided into two groups, those with and those without trauma. Significant deficiencies were detected in the radiographic evaluation of the nontraumatic group, with 35% of these patients having an incomplete or inappropriate CT examination that failed to visualize the full extent of the brachial plexus. In four patients, this led to a significant (greater than 6 months) delay in diagnosis. It was concluded that trauma patients presenting with brachial plexus symptoms should have cervical myelography first, rather than CT. Patients without a history of trauma should be classified on the basis of clinical findings as having central (cord, epidural space, neural foramen) or peripheral (retroclavicular space, axillary apex) disease. If the abnormality is central, myelography should be the first technique used; if peripheral disease is present, CT should be the first study. If the disease extends beyond the confines of the anatomic compartment suggested clinically, the other technique should be used for further evaluation. CT scan protocols for brachial plexus evaluation should employ bolus/drip contrast enhancement to distinguish vascular structures from masses.(ABSTRACT TRUNCATED AT 250 WORDS)