Suresh N Magge1, H Isaac Chen, Eric L Zager. 1. Department of Neurosurgery, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. magges@uphs.upenn.edu
Abstract
OBJECTIVE: Dystrophic calcification refers to heterotopic formation of calcium in soft tissue. There have been few reports that describe dystrophic calcification causing brachial plexopathies. We describe a unique case of dystrophic calcification that caused entrapment of the posterior cord of the brachial plexus, something not previously described in the literature. CLINICAL PRESENTATION: We report the case of a 43-year-old woman with a medical history of congenital lymphangiomas of the left chest wall and axilla, for which she had undergone multiple surgeries and radioactive seed implantation. She presented 41 years later with progressive left arm paresthesias, pain, and weakness. Neurological findings were confined to the distribution of the posterior cord of the plexus. Radiographic evaluation demonstrated a 3 x 3 x 4-cm calcified mass in the axilla and proximal arm. INTERVENTION: A careful neurolysis and mass resection was performed. At exploration, the posterior cord, proximal radial nerve, and brachial artery were found to be densely adherent to a calcified mass. Reconstruction of the brachial artery and free tissue transfer were required for healing of the severely scarred wound. Pathological examination revealed dense, calcified connective tissue consistent with dystrophic calcification. She made an excellent recovery. CONCLUSION: We describe a rare case of dystrophic calcification of the proximal arm causing symptomatic brachial plexopathy, with onset many years after surgery and radiation. Diagnostic evaluation and surgical management are discussed.
OBJECTIVE:Dystrophic calcification refers to heterotopic formation of calcium in soft tissue. There have been few reports that describe dystrophic calcification causing brachial plexopathies. We describe a unique case of dystrophic calcification that caused entrapment of the posterior cord of the brachial plexus, something not previously described in the literature. CLINICAL PRESENTATION: We report the case of a 43-year-old woman with a medical history of congenital lymphangiomas of the left chest wall and axilla, for which she had undergone multiple surgeries and radioactive seed implantation. She presented 41 years later with progressive left arm paresthesias, pain, and weakness. Neurological findings were confined to the distribution of the posterior cord of the plexus. Radiographic evaluation demonstrated a 3 x 3 x 4-cm calcified mass in the axilla and proximal arm. INTERVENTION: A careful neurolysis and mass resection was performed. At exploration, the posterior cord, proximal radial nerve, and brachial artery were found to be densely adherent to a calcified mass. Reconstruction of the brachial artery and free tissue transfer were required for healing of the severely scarred wound. Pathological examination revealed dense, calcified connective tissue consistent with dystrophic calcification. She made an excellent recovery. CONCLUSION: We describe a rare case of dystrophic calcification of the proximal arm causing symptomatic brachial plexopathy, with onset many years after surgery and radiation. Diagnostic evaluation and surgical management are discussed.