Brachial plexus injury from CT-guided RF ablation under general anesthesia.
Brachial plexus injury in a patient under general anesthesia (GA) is not uncommon, despite careful positioning and, particularly, awareness of the possibility. The mechanism of injury is stretching and compression of the brachial plexus over a prolonged period. Positioning the patient within the computed tomography (CT) gantry for abdominal or chest procedures can simulate a surgical procedure, particularly when GA is used. The potential for brachial plexus injury is increased if the case is prolonged and the patient's arms are raised above the head to avoid CT image degradation from streak artifacts. We report a case of profound brachial plexus palsy following a CT-guided radiofrequency ablation procedure under GA. Fortunately, the patient recovered completely. We emphasize the mechanism of injury and detail measures to combat this problem, such that radiologists are aware of this potentially serious complication.
Shankar
Sridhar
S
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 01655, USA. shankars@ummhc.org
Vansonnenberg
Eric
E
Silverman
Stuart G
SG
Tuncali
Kemal
K
Flanagan
Hugh L
HL
Whang
Edward E
EE
D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods; D001917:Brachial Plexus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods; D046152:Gastrointestinal Stromal Tumors / Q000473:pathology / Q000601:surgery; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction; D010243:Paralysis / Q000000981:diagnostic imaging / Q000209:etiology; D011187:Posture; D014057:Tomography, X-Ray Computed