Our patient, a 39-year-old, white female with past medical history of anxiety and chronic obstructive airway disease (COPD) presented with five weeks’ history of left upper extremity pain and a burning sensation. It was progressive in nature and involved the medial arm, shoulder, and lateral thorax. The patient denied any trauma. The intensity of the pain resulted in multiple admissions to the emergency room (ER) with discharge on narcotics for pain control. Later, during the course of her disease, she developed weakness in the left hand. The patient's neurological exam was unremarkable except for decreased sensation to light touch in the distribution of left C7/C8 dermatomes, mild weakness of left triceps, and significant weakness of left-hand grip. The patient had a cervical spine MRI, which showed a 1.25 x 1.25 cm homogenous cystic mass involving the left T1 spinal nerve within the neuroforamen. It appeared hypointense and hyperintense on T1W and T2W imaging respectively (Figure 1).