significant weakness in the right shoulder and biceps, and 4/5 muscle strength in the right first dorsal interosseous and abductor pollicis brevis. Hoffmann sign was positive bilaterally. Lower extremity examination was unremarkable. Setting: An outpatient spine practice. Results: Prior magnetic resonance imaging (MRI) of the cervical spine revealed right paracentral disk herniation at C3-4, with mild disk bulging at C4-5 and C5-6. Prior MRI of brain was unremarkable. Prior computed tomography of the chest also was unremarkable. MRI of the shoulder was ordered, which was unremarkable. An electromyogram of the right upper extremity was performed, which showed a diffuse right brachial plexus injury that primarily affected the upper trunk. Dedicated MRI of the right brachial plexus was ordered and showed a 4-cm mass at the apex of the right lung, which distorted the brachial plexus and subclavian vessels. The patient was referred back to oncology for further evaluation. Discussion: Pancoast tumors can cause Horner syndrome in severe cases: miosis (constriction of the pupils), anhidrosis (lack of sweating), ptosis (drooping of the eyelid), and enophthalmos (sunken eyeball). In progressive cases, the brachial plexus is also affected, which causes pain and weakness in the muscles of the arm and hand. The tumor also can compress the right recurrent laryngeal nerve, which produces a hoarse voice and cough. Treatment may involve radiation, chemotherapy, and/or surgical resection. Conclusions: We present a case of right brachial plexopathy as a result of Pancoast tumor. The patient had a history of lung cancer in remission, which did return. Clinicians should order dedicated MRI of the brachial plexus rather than relying on computed tomography of the chest, in patients who present with these symptoms.

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