Unknown Case: Unilateral Fluorodeoxyglucose Avid Axillary Lymphadenopathy in a Woman With History of Mastectomy and Implant Reconstruction.

Abstract

A 67-year-old female presented with a history of right breast invasive ductal carcinoma and right axillary metastasis five years ago, status post bilateral mastectomies and right axillary lymph node dissection. Three years ago, she underwent implant reconstruction. She was diagnosed with metastasis to mediastinal lymph nodes one year ago after abnormal PET-CT and bronchoscopy. Fluorodeoxyglucose (FDG) PET-CT was performed for surveillance as she is currently on endocrine therapy. Fluorodeoxyglucose PET-CT demonstrated interval increase in size and hypermetabolic activity of a left axillary lymph node when compared to the prior year (Figure 1). Subsequent targeted left axillary US was performed for biopsy of this lymph node (Figure 2). On the biopsy images, the lymph node demonstrates a well-defined anterior margin with hyperechogenicity and echogenic noise. The differential diagnosis for unilateral lymphadenopathy includes benign and malignant etiologies (1,2). Benign etiologies include reactive...