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Unusual brachial plexus lesion: Hematoma masquerading as a peripheral nerve sheath tumor
BACKGROUND: Malignant peripheral nerve sheath tumors (MPNSTs) of the brachial plexus have unique radiographic and clinical findings. Patients often present with progressive upper extremity paresthesias, weakness, and pain. On magnetic resonance (MR) imaging, lesions are isointense on T1-weighted and...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Medknow Publications & Media Pvt Ltd
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4743268/ https://www.ncbi.nlm.nih.gov/pubmed/26904368 http://dx.doi.org/10.4103/2152-7806.174889 |
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author | Krisht, Khaled M. Karsy, Michael Shah, Lubdha M. Schmidt, Meic H. Dailey, Andrew T. |
author_facet | Krisht, Khaled M. Karsy, Michael Shah, Lubdha M. Schmidt, Meic H. Dailey, Andrew T. |
author_sort | Krisht, Khaled M. |
collection | PubMed |
description | BACKGROUND: Malignant peripheral nerve sheath tumors (MPNSTs) of the brachial plexus have unique radiographic and clinical findings. Patients often present with progressive upper extremity paresthesias, weakness, and pain. On magnetic resonance (MR) imaging, lesions are isointense on T1-weighted and hyperintense on T2-weighted sequences, while also demonstrating marked enhancement on MR studies with gadolinium diethylenetriamine pentaacetic acid. On the basis of their characteristic MR imaging features and rapid clinical progression, two brachial plexus lesions proved to be organizing hematomas rather than MPNST. METHODS: A 51-year-old male and a 31-year-old female were both assessed for persistent and worsened left-sided upper extremity pain, paresthesias, and weakness. In both cases, the MR imaging of the brachial plexus demonstrated an extraspinal enhancing lesion located within the left C7–T1 neuroforamina. RESULTS: Although the clinical and radiographic MR features for these 2 patients were consistent with MPNSTs, both lesions proved to be benign organizing hematomas. CONCLUSIONS: These two case studies emphasize that brachial plexus hematomas may mimic MPNSTs on MR studies. Accurate diagnosis of these lesions is critical for determining the appropriate management options and treatment plans. Delaying the treatment of a highly aggressive nerve sheath tumor can have devastating consequences, whereas many hematomas resolve without surgery. Therefore, if the patient has stable findings on neurological examination and a history of trauma, surgical intervention may be delayed in favor of repeat MR imaging in 2–3 months to re-evaluate the size of the mass. |
format | Online Article Text |
id | pubmed-4743268 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Medknow Publications & Media Pvt Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-47432682016-02-22 Unusual brachial plexus lesion: Hematoma masquerading as a peripheral nerve sheath tumor Krisht, Khaled M. Karsy, Michael Shah, Lubdha M. Schmidt, Meic H. Dailey, Andrew T. Surg Neurol Int Surgical Neurology International: Spine BACKGROUND: Malignant peripheral nerve sheath tumors (MPNSTs) of the brachial plexus have unique radiographic and clinical findings. Patients often present with progressive upper extremity paresthesias, weakness, and pain. On magnetic resonance (MR) imaging, lesions are isointense on T1-weighted and hyperintense on T2-weighted sequences, while also demonstrating marked enhancement on MR studies with gadolinium diethylenetriamine pentaacetic acid. On the basis of their characteristic MR imaging features and rapid clinical progression, two brachial plexus lesions proved to be organizing hematomas rather than MPNST. METHODS: A 51-year-old male and a 31-year-old female were both assessed for persistent and worsened left-sided upper extremity pain, paresthesias, and weakness. In both cases, the MR imaging of the brachial plexus demonstrated an extraspinal enhancing lesion located within the left C7–T1 neuroforamina. RESULTS: Although the clinical and radiographic MR features for these 2 patients were consistent with MPNSTs, both lesions proved to be benign organizing hematomas. CONCLUSIONS: These two case studies emphasize that brachial plexus hematomas may mimic MPNSTs on MR studies. Accurate diagnosis of these lesions is critical for determining the appropriate management options and treatment plans. Delaying the treatment of a highly aggressive nerve sheath tumor can have devastating consequences, whereas many hematomas resolve without surgery. Therefore, if the patient has stable findings on neurological examination and a history of trauma, surgical intervention may be delayed in favor of repeat MR imaging in 2–3 months to re-evaluate the size of the mass. Medknow Publications & Media Pvt Ltd 2016-01-25 /pmc/articles/PMC4743268/ /pubmed/26904368 http://dx.doi.org/10.4103/2152-7806.174889 Text en Copyright: © 2016 Surgical Neurology International http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. |
spellingShingle | Surgical Neurology International: Spine Krisht, Khaled M. Karsy, Michael Shah, Lubdha M. Schmidt, Meic H. Dailey, Andrew T. Unusual brachial plexus lesion: Hematoma masquerading as a peripheral nerve sheath tumor |
title | Unusual brachial plexus lesion: Hematoma masquerading as a peripheral nerve sheath tumor |
title_full | Unusual brachial plexus lesion: Hematoma masquerading as a peripheral nerve sheath tumor |
title_fullStr | Unusual brachial plexus lesion: Hematoma masquerading as a peripheral nerve sheath tumor |
title_full_unstemmed | Unusual brachial plexus lesion: Hematoma masquerading as a peripheral nerve sheath tumor |
title_short | Unusual brachial plexus lesion: Hematoma masquerading as a peripheral nerve sheath tumor |
title_sort | unusual brachial plexus lesion: hematoma masquerading as a peripheral nerve sheath tumor |
topic | Surgical Neurology International: Spine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4743268/ https://www.ncbi.nlm.nih.gov/pubmed/26904368 http://dx.doi.org/10.4103/2152-7806.174889 |
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