게시판
| 21KS-020 |
Complex Regional Pain Syndrome caused by Brachial Metastasis Masquerading as Radiation-induced Brachial Plexopathy
Department of Anesthesiology and Pain Medicine, Keimyung University School of Medicine, Dongsan Hospital
Introduction
Radiation induced brachial plexopathy (RIBP) reveal pain, paresthesia, edema, and weakness. Radiation caused delayed damage to mature nerve tissue. Pain degree is variable but severe pain should be considered cancer recurrence.
Case report
63years old female patient who got operation of right mastectomy with axillary lymph node dissection 6 months ago, visited pain clinic due to intolerable pain. 3months later operation, radiation therapy with intensity modulated radiation therapy 5000cGy/25fr at Rt axilla was done. After radiation therapy, pain was aggravated. The patient complained severe pain visual analogue scale 9~10. In out patients clinic, serratus anterior plane block and pectoral nerve block were conducted with ultrasound and epidural catheter insertion after admission under impression of radiation induced brachial plexopathy. Pain did not reduce under VAS 7, she was diagnosis as CRPS type 2 at other hospital(figure 1). 3 months later, intrathcal pump was inserted with infusion dose 1.2mg per day for pain control at our hospital. During treatment, recurrence of breast cancer and invasion to brachial plexus at infraclavicular area, was diagnosed(figure 2). Chemotherapy was planned for further treatment.
Conclusion
Incidence of brachial plexopathy from breast cancer is 0.5%. Cancer induce cytokine upregulation and reveal CRPS like symptoms. Symptoms of RIBP are variable and confused with the symptoms by cancer recurrence and invasion to nerve tissue. Therefore, treatments under diagnosis of RIBP should be carefully combined examination for possibility of cancer recurrence.
Radiation induced brachial plexopathy (RIBP) reveal pain, paresthesia, edema, and weakness. Radiation caused delayed damage to mature nerve tissue. Pain degree is variable but severe pain should be considered cancer recurrence.
Case report
63years old female patient who got operation of right mastectomy with axillary lymph node dissection 6 months ago, visited pain clinic due to intolerable pain. 3months later operation, radiation therapy with intensity modulated radiation therapy 5000cGy/25fr at Rt axilla was done. After radiation therapy, pain was aggravated. The patient complained severe pain visual analogue scale 9~10. In out patients clinic, serratus anterior plane block and pectoral nerve block were conducted with ultrasound and epidural catheter insertion after admission under impression of radiation induced brachial plexopathy. Pain did not reduce under VAS 7, she was diagnosis as CRPS type 2 at other hospital(figure 1). 3 months later, intrathcal pump was inserted with infusion dose 1.2mg per day for pain control at our hospital. During treatment, recurrence of breast cancer and invasion to brachial plexus at infraclavicular area, was diagnosed(figure 2). Chemotherapy was planned for further treatment.
Conclusion
Incidence of brachial plexopathy from breast cancer is 0.5%. Cancer induce cytokine upregulation and reveal CRPS like symptoms. Symptoms of RIBP are variable and confused with the symptoms by cancer recurrence and invasion to nerve tissue. Therefore, treatments under diagnosis of RIBP should be carefully combined examination for possibility of cancer recurrence.
