Case Report: Upper limb dysfunction may be caused by chest wall mass excision: An enlightenment from a special case

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Neurosurgery

Background:

• Chest wall surgery is perceived as a low-risk procedure.
• Axillary masses can pose diagnostic and surgical challenges.
• Preoperative imaging may not fully predict post-operative complications.

Observation:

• A patient presented with a left chest wall adjacent axillary mass, initially identified as an abnormal lymph node via ultrasound and CT.
• The mass did not impede the patient's upper limb mobility pre-operatively.
• Post-resection, the patient developed significant numbness and pain in the left ring and little fingers.

Findings:

• Pathology confirmed the axillary mass to be a schwannoma with cystic degeneration.
• The surgical removal of the chest wall mass resulted in iatrogenic left upper limb nerve dysfunction.
• The patient experienced persistent neuropathic pain impacting sleep.

Implications:

• This case underscores the potential for severe complications, including nerve damage, in seemingly routine chest wall and axillary mass resections.
• Thoracic surgeons must exercise heightened vigilance and not solely rely on imaging diagnoses for risk assessment.
• Patients should be informed about the possibility of unexpected functional deficits following such procedures.