Radiation-Induced Brachial Plexopathy Differential Diagnoses

Updated: Apr 02, 2019
  • Author: Ryan O Stephenson, DO; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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DDx

Diagnostic Considerations

Table. Other Problems to Consider in Radiation-Induced Brachial Plexopathy Diagnosis (Open Table in a new window)

Feature

Tumor Infiltration

Radiation Fibrosis

Transient Radiation Injury

Acute Ischemic Injury

Incidence of pain

80%

18%

40%

Painless

Location of pain

Shoulder, upper arm, elbow, fourth and fifth fingers

Shoulder, wrist, hand

Hand, forearm

Hand, forearm

Nature of pain

Dull ache in shoulder, lancinating pains in elbow and ulnar aspect of hand; occasional paresthesias and dysesthesias

Ache in shoulder; prominent paresthesias in C-5/C-6 distribution of hand and arm

Ache in shoulder; prominent paresthesias in C-5/C-6 distribution of hand and arm

Paresthesias in C-5/C-6 distribution of hand and arm

Severity

Moderate to severe (severe in 98%)

Usually mild to moderate

(severe in 20-35%)

Mild

Mild

Course

Progressive neurologic dysfunction; atrophy and weakness in C-7/T-1 distribution, persistent pain; occasional Horner syndrome

Progressive weakness; panplexus or upper plexus distribution; Horner syndrome uncommon

Translate weakness with complete resolution

Acute nonprogressive weakness and sensory loss

Study findings

 

 

 

 

Magnetic resonance imaging

High signal intensity on T2-weighted images; may enhance with gadolinium

Low signal intensity on T2-weighted images; generally nonenhancing with gadolinium

No data

Normal

Computed tomography

Mass; circumscribed or diffuse tissue infiltration

Diffuse tissue infiltration

Normal

Angiography demonstrates subclavian artery segmental

obstruction

Electromyography

Segmental slowing

Diffuse myokymia

Segmental slowing

Segmental slowing

Differential Diagnoses