CASE 550 Published on 06.11.2000
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Blunt traumatic avulsion of the left brachial plexus

Section

Chest imaging

Case Type

Clinical Cases

Authors

M. Wintermark, P. Schnyder

Connected authors
Pierre SCHNYDER SWITZERLAND
Patient

23 years, male

Categories
No Area of Interest ; Imaging Technique CT
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Clinical History
Motorcycle accident with a close forequarter amputation
Imaging Findings
23-year-old male motorcycle driver involved in a traffic accident and whose neurological examination in the emergency room demonstrated a complete left brachial plexus palsy.
Discussion
In 90% of cases, scapulo-thoracic dissociation is associated with severe neuro-vascular damage: brachial plexus avulsion is encountered in 94% of cases and lesions of the subclavian or vertebral vessels in 80%. Brachial plexus avulsions may also induce an ipsilateral diaphragmatic paralysis, since the brachial plexus and phrenic nerve origins are near each other: whereas the brachial plexus originates in the C5-T1 nerve roots, the phrenic nerve refers to a large root from the C4 ventral ramus, with small contributions from the C3 and C5 ventral rami.
Differential Diagnosis List
Blunt traumatic avulsion of the left brachial plexus as part of a scapulo-thoracic dissociation
Final Diagnosis
Blunt traumatic avulsion of the left brachial plexus as part of a scapulo-thoracic dissociation
Case information
URL: https://eurorad.org/case/550
DOI: 10.1594/EURORAD/CASE.550
ISSN: 1563-4086
Figure 1

Blunt traumatic avulsion of the left brachial plexus

Blunt traumatic avulsion of the left brachial plexus
A myelography and a myelo-CT performed ten days later after the trauma display a complete avulsion of the left branchial plexus, with extensive intra- and extra-canalar contrast material leak from C5 to T2. The spinal cord is shifted rightwards by an intradural hematoma (From Wintermark M, Schnyder P (2000) Trauma of the chest wall. In Schnyder P, Wintermark M. Radiology of blunt trauma of the chest. Springer, Berlin Heidelberg New York, pp 9-27)
Blunt traumatic avulsion of the left brachial plexus
A myelography and a myelo-CT performed ten days later after the trauma display a complete avulsion of the left branchial plexus, with extensive intra- and extra-canalar contrast material leak from C5 to T2. The spinal cord is shifted rightwards by an intradural hematoma (From Wintermark M, Schnyder P (2000) Trauma of the chest wall. In Schnyder P, Wintermark M. Radiology of blunt trauma of the chest. Springer, Berlin Heidelberg New York, pp 9-27)