Type:
Educational Exhibit
Keywords:
Breast, Mammography, MR, Ultrasound, Biopsy, Arteriovenous malformations, Cancer, Cysts
Authors:
T. Chan, C. FISCHER
DOI:
10.26044/ecr2022/C-17302
Findings and procedure details
An abnormal lymph node is characterized by a thickened or eccentrically thickened cortex with an effaced or absent fatty hilum, and can represent a reactive process such as vaccination or sequelae from malignancy.
The most common malignancy to metastasize to the axillary lymph node is primary breast malignancy and is often high in the early differential.
Non breast malignancies, such as soft tissue sarcomas, are important to distinguish due to their aggressive nature and necessary treatment regimen. Sarcomas represent a diverse group of malignancies that originate from the mesenchymal tissue and as a result, they can arise from any location in the body and affect all age groups (Figure 1).
There are also several benign findings that can be found in the axilla that may resemble a reactive lymph node. For example, paralabral cysts are often associated with labral tears and can cause pain, weakness, and denervation of the supraspinatus and infraspinatus muscles secondary to nerve compression (Figure 2). These are benign and biopsy is not recommended for confirmation.
Another important benign entity to distinguish are venous malformations, up to 40% of which are located in the extremities (Figure 3). Vascular malformations are categorized as low flow (venous, lymphatic, capillary) or high flow (arteriovenous). This entity is congenital but patients tend to develop symptoms in their late childhood or early adulthood. Recognizing a potential vascular malformation in the axilla will prevent unnecessary biopsy, which would cause significant bleeding.