Intramammary lymph nodes (IMLN) are lymph nodes within the breast tissue. In breast imaging, they generally fall into BIRADS II lesions 7. They can be solitary or multiple. This article discusses normal (physiological) intramammary lymph nodes.
Intramammary lymph nodes are seen in ~5% of mammographic studies 2.
They can occur in any portion of the breast. There may be predilection for the upper outer quadrant (towards the axillary tail) 2-3.
Nodes are usually less than 1cm in greatest diameter. They are seen seen as a circumscribed oval or reniform non-calcified mass with a central or peripheral lucency that represents fat within the hilum. The IMLN is often projected over the pectoral muscle profile as a well defined, smoothly circumscribed low density lesion with no spiculation. The majority (~78%) of lesions have a lower density at the center than at the periphery on mammography 3. Sometimes a "hilar notch" may be seen. The node may change slightly is size on follow up mammograms but generally they can be tracked on follow up mammograms and stay constant in size an position. They have been know to disappear but in practcie you will see them every time the patient is imaged.
There are two critical issues in evaluating an IMLN on mammogram: the first is that without exception the nodes are smoothly circumscribed and well defined. If the lesion is not very neatly and clearly outlined or loses this feature on follow up studies, it is not a simple node. The second is these are low density lesions. If it is projected over the profile of the muscle, you will see the muscle through the node. If this feature disappears or the "node" increases with density on follow up you are not dealing with a simple lymphnode. To judge the density of a node. look for one up in the tail of the breast on the MLO view - they should have similar densities.
If these two criteria are kept in mind, these lesions will rarely cause confusion or misdiagnosis.
Usually detected as a solid reniform lesion which is hypoechoic 5 to the remainder of the breast tissue and with a similar shape to that described on mammography. The outer margin is typically well defined. A hyperechoic central area resulting from the hilar fat may be seen. Sometimes a nearby blood vessel may be seen with some flow entering the hilum on colour Doppler interrogation.
Some authors suggest that intra mammary nodes with classical features as pathognomonic. Other authors however suggest that a lesion with radiographic features of an intramammary lymph node may rarely hide an early breast cancer 6.
Normal intramammary lymph nodes may appear or enlarge in the breast as a reaction to inflammatory conditions of the skin but also as a reaction to metastatic involvement. When they do so, a round, well defined, homogeneous, high-density mass, larger than 1cm in diameter may be seen. See main article: metastatic intramammary lymph node.
- thoracic skeleton
- thoracic cage
- thoracic spine
- muscles of the thorax
- intercostal muscles
- variant anatomy
- spaces of the thorax
- tracheobronchial tree
bronchopulmonary segmental anatomy
- left lung
- right lung
- variant anatomy
- lung parenchyma
- bronchopulmonary segmental anatomy
- cardiac chambers
- heart valves
- pectinate muscles
- coronary circulation
- innervation of the heart
- nipple-areola complex
- terminal ductal lobular unit
- axillary tail
- mammary fat
- Montgomery glands
- Cooper ligaments
- Chassaignac bursa
- lymphatic drainage
- blood supply of the thorax
thoracic aorta (development | variant anatomy)
- ascending aorta
- brachiocephalic trunk
- common carotid artery
- subclavian artery
- variant anatomy
- aortic isthmus
- descending aorta
- pulmonary trunk
- thoracic aorta (development | variant anatomy)
- superior vena cava (cavo-atrial junction | variant anatomy)
- inferior vena cava
- cardiac veins
- pulmonary veins
- innervation of the thorax
- 1. Jadusingh IH. Intramammary lymph nodes. J. Clin. Pathol. 1992;45 (11): 1023-6. J. Clin. Pathol. (link) - Free text at pubmed - Pubmed citation
- 2. Meyer JE, Ferraro FA, Frenna TH et-al. Mammographic appearance of normal intramammary lymph nodes in an atypical location. AJR Am J Roentgenol. 1993;161 (4): 779-80. AJR Am J Roentgenol (citation) - Pubmed citation
- 3. Svane G, Franzén S. Radiologic appearance of nonpalpable intramammary lymph nodes. Acta Radiol. 1993;34 (6): 577-80. - Pubmed citation
- 4. Appelbaum AH, Evans GF, Levy KR et-al. Mammographic appearances of male breast disease. Radiographics. 19 (3): 559-68. Radiographics (full text) - Pubmed citation
- 5. Gordon PB, Gilks B. Sonographic appearance of normal intramammary lymph nodes. J Ultrasound Med. 1988;7 (10): 545-8. J Ultrasound Med (abstract) - Pubmed citation
- 6. Jellici E, Minniti S, Malagò R et-al. Focal breast lesions with benign appearances. Review of eight breast cancers with initial features of intramammary lymph node. Radiol Med. 2006;111 (8): 1078-86. doi:10.1007/s11547-006-0106-4 - Pubmed citation
- 7. Orel SG, Kay N, Reynolds C et-al. BI-RADS categorization as a predictor of malignancy. Radiology. 1999;211 (3): 845-50. Radiology (full text) - Pubmed citation
- 8. Conant EF, Brennecke CM. Breast imaging, case review. Mosby Inc. (2006) ISBN:0323017460. Read it at Google Books - Find it at Amazon
- 9. Eurorad teaching files : Case 363
- 10. Paredes ES. Atlas of mammography. Lippincott Williams & Wilkins. (2007) ISBN:0781764335. Read it at Google Books - Find it at Amazon
Synonyms & Alternative Spellings
|Synonyms or Alternative Spelling||Include in Listings?|
|Intramammary lymph node||✗|
|Intra-mammary lymph nodes||✗|
|Intramammary lymph nodes (IMLN)||✗|
|Internal mammary lymph nodes||✗|
|Internal mammary nodes||✗|