Case 51: Malignant Breast Mass with Axillary Nodal Metastasis || BIRADS 6 || Ultrasound || Doppler

        

Clinical Features:

- A 32 years old female patient came with a right breast lump.

- Histopathology revealed Invasive Ductal Carcinoma.

- She also complained about the right axillary lump.

Ultrasound Features:

Rt Breast

- An irregular, heterogeneously hypoechoic, taller than wide, non-parallel mass causing architectural distortion of the mammary layer with invasion into the premammary layer & compression over the underlying retromammary muscles, is noted at the 9 o'clock position of the right breast just inferolateral to the nipple.

- Color Doppler shows, high internal vascularity with intratumoral moderate impedance flow (RI: 0.75) which goes in favor of malignant nature.

Rt Axilla

- Multiple enlarged lymph nodes are seen at the right axilla with loss of normal hilar echoes.

- Color Doppler shows, high internal vascularity with multiple transcapsular feeding vessels.

- Nodal hilar arteries show, high impedance flow (RI: 0.93) which goes in favor of metastatic nodes.

Remember:

Due to compression over the hilum, the hilar arteries in case of lymph node metastasis show high flow resistance.

Ultrasound Images:

Fig: Rt breast mass with TVS probe.

Fig: Irregular breast mass with increased internal vascularity on Doppler

Fig: Spectral Doppler from intratumoral vessel. Moderate impedance flow (RI: 0.75) is seen which goes in favor of malignant nature.

Fig: Multiple enlarged right axillary lymph nodes with loss of hilar normal echoes

Fig: Nodal increased internal vascularity on Doppler with multiple transcapsular feeding vessels.

Fig: Enlarged lymph nodes with increased internal vascularity on Doppler with multiple transcapsular feeding vessels.

Fig: Nodal hilar arteries show, high impedance flow (RI: 0.93) which goes in favor of metastatic nodes.

YouTube Video Link:

https://youtu.be/Mny7hPaUYRM