F-18 FDG PET-CT appearance of metastatic brachial plexopathy in a case of carcinoma of the breast.

A 62-year-old woman who had surgery for carcinoma of the left breast (infiltrating duct cell carcinoma grade III) and was postchemotherapy and local radiotherapy presented after 10 years with severe pain in the left shoulder and left arm. Routine follow-up investigations in these 10 years had been within normal limits. She also had a history of cervical spondylosis. A bone scan showed increased MDP uptake in the L5 and D9 vertebrae and a low-grade increase in both shoulders and knee joints, suggestive of degenerative changes. MRI showed hyper-intense signal and thickening of retro- and infraclavicular portions of the left brachial plexus (metastatic?). The patient was referred for a PET-CT scan to assess the disease status. PET-CT imaging with F-18 FDG confirmed increased metabolism in the brachial plexus suggestive of tumor infiltration.