Lymph nodes on mammogram of the right breast

Case contributed by Dr Garth Kruger

Presentation

An initial screening study of the right breast

Patient Data

Age: 50
Gender: Female
Modality: Mammography

The images are 9 months apart. On the initial mammogram, the MLO view is a screening study.

The study is read as normal. The parenchymal density at 12 o'clock catches the eye but is not mentioned. Note the position of the lymph nodes and their density.

Modality: Mammography

The area of asymmetry at 12 o'clock is now apalpable and the patient is sent for diagnostic mammography.

The salient point here is note how the nodes are denser, but not bigger? The nodes in the apex of the axilla are still normal with fatty hila. 

The abnormal nodes are a red flag. You should be looking for a  focal lesion in the breast. Do not be tempted to discount this finding in every day practice.

Modality: Ultrasound

Case Discussion:

This case illustrates how important it is review of the nodes. The nodes can increase in density and do not have to enlarge to be potentially pathological.

This patient had a small IDC (infiltrating ductal carcinoma) at 12 o' clock with positive node metastases on axilla dissection following sentinel node biopsy.

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Case Information:

rID: 21555
Diagnostic certainty: Possible
System: Breast
Inclusion in quiz mode: Included

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