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Clinical history in combination with ultrasound, magnetic resonance imaging, and positron emission tomography (PET) can assess whether symptoms are due to neurotrophic tumor infiltrate versus radiation plexopathy or another cause. In this patient 1 with infraclavicular disease and prior radiation, symptoms are likely from direct tumor involvement or prior radiation.

Clinically, painless upper trunk lesions with lymphedema correlate with radiation injury, whereas painful lower trunk lesions are more often related to neoplastic infiltration. On magnetic resonance imaging, both radiation plexopathy and tumor appear as hypointense on T1 and have increased T2 signal. On PET, radiation injury is only mildly avid, whereas tumor is often hypermetabolic. 2 The PET avidity and pain in this patient is consistent with tumor. Increased dose correlates with pain relief in patients with carcinomatous plexopathy. A biologically …