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Normal Findings - Palpable Lump Bilateral Axillary

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In this case, we have a 38 year old female presenting with bilateral

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axillary palpable findings, which have been present for some time, and she

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comes in for further imaging evaluation. Now, we'll start with, again,

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looking at our overall full field CC and MLO views. In this patient,

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she had no prior history of having any imaging, so nothing to compare

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to, so we'll get all the full field views as well.

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We have pretty good image quality, I would say. The pectoralis muscles do

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not come down all the way to the level of the nipple, so

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we would hope to get even a little more pectoralis muscle in these

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images. Now, it's probably okay, probably adequate for what we need for

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today's exam, but you might wonder or ask your technologist about this,

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potentially. Sometimes patients are more difficult to pull on, particularly

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those patients with more dense breasts. So, let me first adjust the CC views

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for us. In the CC views, the SM views here,

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we notice that there's no BB marker in the CC, as far as

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we can tell. Now, we would expect it in the lateral aspect of

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the breast, because we know that these were axillary findings, but we also

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sort of don't expect to see them, because

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it's very difficult to get axillary tissue on a CC view. Now, our technologist

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did try XCCL views in this case, and again, we still don't see

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any palpable marker on the CC view. Now, we'll look at the rest

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of the breast, just to make sure we're not missing anything else,

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but we don't see anything abnormal in this case. Technologists will do spot

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compression views over the palpable abnormality. In this case, they were

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able to get the axillary palpable findings very high up in the axilla. We

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can see our markers here and here. And if we switch over to

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the DVT views, we can scroll through the imaging stack to take a

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closer look. Now, of course, in this case, we'll start in the lateral

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aspect and move immediately. Our palpable BB marker is coming into view.

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And underlying, we see some wispy fibroglandular tissue, which is directly

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underlying that marker. And then we also can see some normal appearing axillary

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lymph nodes. Now, it's a little bit unclear whether she's feeling maybe

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that axillary tissue or the lymph nodes, but it's something we can ask

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her as a technologist to confirm with the patient.

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Similarly, on the left side, we see the palpable BB marker is just

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at the margin of our spot compression paddle. And underline, we again see

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this sort of normal wispy fibroglandular tissue, and then again, some normal

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left axillary lymph nodes. Now, in this case, the patient did go on

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to ultrasound. She had bilateral axillary ultrasound, which showed both

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of these findings. Again, some normal axillary glandular tissue, some normal

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appearing lymph nodes, all looked well. It's very likely that she's feeling

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a little bit of this axillary tissue, and for whatever reason,

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just happened to feel it at that point.

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But she can be reassured and sent back to her

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referring provider and just undergo routine screening, preferably at age

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40.

Report

Faculty

Ryan W. Woods, MD, MPH

Assistant Professor of Radiology

University of Wisconsin School of Medicine and Public Health

Tags

Women's Health

Ultrasound

Tomosynthesis

Oncologic Imaging

Mammography

Breast

AI Technologies

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