0:00

Okay, this is a 56-year-old patient,

0:03

uh, presenting for screening mammogram.

0:06

You see that the quality of this exam is

0:08

good, good evaluation of the pectoralis muscles.

0:12

Uh, IMS looks okay, and

0:13

appropriate CC images. Right away,

0:16

we can see she has several, uh, large

0:18

abnormal lymph nodes in both axillary regions.

0:22

In addition, we see this, uh, um, axillary tail or

0:26

intermammary lymph node in the left breast, uh, upper outer

0:29

left breast, probably about two o'clock position.

0:32

If this was a patient's first exam and we didn't

0:34

see these lymph nodes before, we would certainly

0:36

recommend that she undergo diagnostic ultrasound,

0:39

probably at both sides, and possible biopsy.

0:42

This patient had that, uh, procedure done

0:44

a number of years ago, and indeed, several

0:47

enlarged right lymph nodes were identified,

0:50

one biopsied,

0:52

demonstrating CLL.

0:54

Now, if this patient, um, goes along and

0:56

has her CLL, um, treated appropriately,

0:59

we may see that these lymph nodes, uh,

1:02

resolve or become more normalized over time.

1:04

And then we may see them come back.

1:07

Now if we see them come back, that's

1:09

okay from an imaging perspective,

1:11

and we can still evaluate this exam

1:14

for, uh, separate, um, breast malignancy.

1:17

And if you know that the patient has a history

1:19

of CLL or has current, um, active CLL and you see

1:22

multiple large nodes, then the most appropriate

1:25

RADS assessment for that exam is a RADS 2,

1:28

uh, assuming that you don't see anything else

1:29

in the breast, um, and you can say that there's

1:31

stable axillary adenopathy compatible

1:34

with the patient's clinical history of CLL.

1:36

Now if this is new or something changes in

1:38

some way, then of course the most appropriate

1:40

interpretation would be BI-RADS 0, recommending

1:42

additional diagnostic, uh, exams, most likely

1:46

ultrasound, and then possible subsequent.

Axillary Adenopathy - Bilateral / History of Chronic Lymphocytic Leukemia (CLL)

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0:00

Okay, this is a 56-year-old patient,

0:03

uh, presenting for screening mammogram.

0:06

You see that the quality of this exam is

0:08

good, good evaluation of the pectoralis muscles.

0:12

Uh, IMS looks okay, and

0:13

appropriate CC images. Right away,

0:16

we can see she has several, uh, large

0:18

abnormal lymph nodes in both axillary regions.

0:22

In addition, we see this, uh, um, axillary tail or

0:26

intermammary lymph node in the left breast, uh, upper outer

0:29

left breast, probably about two o'clock position.

0:32

If this was a patient's first exam and we didn't

0:34

see these lymph nodes before, we would certainly

0:36

recommend that she undergo diagnostic ultrasound,

0:39

probably at both sides, and possible biopsy.

0:42

This patient had that, uh, procedure done

0:44

a number of years ago, and indeed, several

0:47

enlarged right lymph nodes were identified,

0:50

one biopsied,

0:52

demonstrating CLL.

0:54

Now, if this patient, um, goes along and

0:56

has her CLL, um, treated appropriately,

0:59

we may see that these lymph nodes, uh,

1:02

resolve or become more normalized over time.

1:04

And then we may see them come back.

1:07

Now if we see them come back, that's

1:09

okay from an imaging perspective,

1:11

and we can still evaluate this exam

1:14

for, uh, separate, um, breast malignancy.

1:17

And if you know that the patient has a history

1:19

of CLL or has current, um, active CLL and you see

1:22

multiple large nodes, then the most appropriate

1:25

RADS assessment for that exam is a RADS 2,

1:28

uh, assuming that you don't see anything else

1:29

in the breast, um, and you can say that there's

1:31

stable axillary adenopathy compatible

1:34

with the patient's clinical history of CLL.

1:36

Now if this is new or something changes in

1:38

some way, then of course the most appropriate

1:40

interpretation would be BI-RADS 0, recommending

1:42

additional diagnostic, uh, exams, most likely

1:46

ultrasound, and then possible subsequent.

Report

Faculty

Ryan W. Woods, MD, MPH

Assistant Professor of Radiology

University of Wisconsin School of Medicine and Public Health

Lesson

Pre-Course Activities

Lesson

Introduction to Tomosynthesis

Lesson

Approach to Interpretation and Lesion Localization

Lesson

Normal Imaging Findings

Lesson

Asymmetries and Masses

Lesson

Gynecomastia

Lesson

Fat-containing Lesions

Lesson

Architectural Distortion

Lesson

Calcifications

Lesson

Associated Findings

Lesson

Postsurgical Findings

Axillary Adenopathy - Bilateral / History of Chronic Lymphocytic Leukemia (CLL)