HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) CME Test (opens in a new window) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kim, S. M. Articles by Park, J. M. Search for Related Content PubMed PubMed Citation Articles by Kim, S. M. Articles by Park, J. M. Related Collections Breast (Imaging and Interventional) Ultrasound

Normal and Abnormal US Findings at the Mastectomy Site¹

¹ From the Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388–1 Pungnap-dong, Songpa-gu, Seoul 138–736, Korea. Recipient of a Certificate of Merit award for an education exhibit at the 2002 RSNA scientific assembly. Received March 17, 2003; revision requested May 7 and received June 26; accepted June 27. Both authors have no financial relationships to disclose. Address correspondence to J.M.P., Department of Radiology, University of Wisconsin Hospital and Clinics G3/120, 600 Highland Ave, Madison, WI 53792-1840 (e-mail: jmpark@mail.radiology.wisc.edu).

View larger version (106K): [in a new window]   Figure 1a. (a) Transverse US image and diagram of a normal mastectomy site. (b) Sagittal US image and diagram of a normal mastectomy site. (c) Transverse Doppler US image and diagram of a normal internal mammary area. (d) Transverse US image and diagram of a normal axilla (level I). (e) Transverse US image and diagram of a normal supraclavicular site.

View larger version (106K): [in a new window]   Figure 1b. (a) Transverse US image and diagram of a normal mastectomy site. (b) Sagittal US image and diagram of a normal mastectomy site. (c) Transverse Doppler US image and diagram of a normal internal mammary area. (d) Transverse US image and diagram of a normal axilla (level I). (e) Transverse US image and diagram of a normal supraclavicular site.

View larger version (116K): [in a new window]   Figure 1c. (a) Transverse US image and diagram of a normal mastectomy site. (b) Sagittal US image and diagram of a normal mastectomy site. (c) Transverse Doppler US image and diagram of a normal internal mammary area. (d) Transverse US image and diagram of a normal axilla (level I). (e) Transverse US image and diagram of a normal supraclavicular site.

View larger version (81K): [in a new window]   Figure 1d. (a) Transverse US image and diagram of a normal mastectomy site. (b) Sagittal US image and diagram of a normal mastectomy site. (c) Transverse Doppler US image and diagram of a normal internal mammary area. (d) Transverse US image and diagram of a normal axilla (level I). (e) Transverse US image and diagram of a normal supraclavicular site.

View larger version (101K): [in a new window]   Figure 1e. (a) Transverse US image and diagram of a normal mastectomy site. (b) Sagittal US image and diagram of a normal mastectomy site. (c) Transverse Doppler US image and diagram of a normal internal mammary area. (d) Transverse US image and diagram of a normal axilla (level I). (e) Transverse US image and diagram of a normal supraclavicular site.

View larger version (186K): [in a new window]   Figure 2a. Seroma in a 51-year-old woman who presented with redness and a palpable lesion at the mastectomy site 7 months after modified radical mastectomy of the left breast. Transverse US images of the chest wall show partial views (a, medial part; b, lateral part) of a septated cystic lesion (arrows) in association with a slight thickening of the skin at the mastectomy site. The diagnosis was seroma with cellulitis or edema.

View larger version (169K): [in a new window]   Figure 2b. Seroma in a 51-year-old woman who presented with redness and a palpable lesion at the mastectomy site 7 months after modified radical mastectomy of the left breast. Transverse US images of the chest wall show partial views (a, medial part; b, lateral part) of a septated cystic lesion (arrows) in association with a slight thickening of the skin at the mastectomy site. The diagnosis was seroma with cellulitis or edema.

View larger version (128K): [in a new window]   Figure 3a. Postoperative fibrosis in a 37-year-old woman who had undergone left modified radical mastectomy 6 months prior to US evaluation for a newly developed nodule found on a contralateral mammogram. Transverse (a) and sagittal (b) US images of the axilla show a well-defined irregular hypoechoic lesion (arrows) at the site of previous axillary node dissection. This lesion changed shape when compressed, a finding inconsistent with malignancy.

View larger version (133K): [in a new window]   Figure 3b. Postoperative fibrosis in a 37-year-old woman who had undergone left modified radical mastectomy 6 months prior to US evaluation for a newly developed nodule found on a contralateral mammogram. Transverse (a) and sagittal (b) US images of the axilla show a well-defined irregular hypoechoic lesion (arrows) at the site of previous axillary node dissection. This lesion changed shape when compressed, a finding inconsistent with malignancy.

View larger version (116K): [in a new window]   Figure 4a. Recurrent ductal carcinoma in a 54-year-old woman who had undergone left modified radical mastectomy 5 years prior to US for a palpable nodule at the mastectomy site. (a) Transverse US image of the chest wall shows an ill-defined irregular hypoechoic lesion (arrows) at the mastectomy site. The radiologic diagnosis was confirmed at biopsy. (b) Transverse image from real-time US monitoring at fine needle aspiration biopsy shows the needle tip (arrowheads) during placement in the lesion (arrows).

View larger version (121K): [in a new window]   Figure 4b. Recurrent ductal carcinoma in a 54-year-old woman who had undergone left modified radical mastectomy 5 years prior to US for a palpable nodule at the mastectomy site. (a) Transverse US image of the chest wall shows an ill-defined irregular hypoechoic lesion (arrows) at the mastectomy site. The radiologic diagnosis was confirmed at biopsy. (b) Transverse image from real-time US monitoring at fine needle aspiration biopsy shows the needle tip (arrowheads) during placement in the lesion (arrows).

View larger version (123K): [in a new window]   Figure 5a. Recurrent ductal carcinoma in a 45-year-old woman who had undergone left modified radical mastectomy 15 months prior to US for a palpable nodule at the mastectomy site. (a) Transverse US image of the chest wall shows an ill-defined irregular hypoechoic lesion (arrows) at the mastectomy site. The diagnosis was confirmed with US-guided fine needle aspiration biopsy. (b) Photomicrograph (original magnification, x40; hematoxylin-eosin stain) of a specimen from excision biopsy shows recurrent invasive ductal carcinoma (arrows) in the fat tissue.

View larger version (120K): [in a new window]   Figure 5b. Recurrent ductal carcinoma in a 45-year-old woman who had undergone left modified radical mastectomy 15 months prior to US for a palpable nodule at the mastectomy site. (a) Transverse US image of the chest wall shows an ill-defined irregular hypoechoic lesion (arrows) at the mastectomy site. The diagnosis was confirmed with US-guided fine needle aspiration biopsy. (b) Photomicrograph (original magnification, x40; hematoxylin-eosin stain) of a specimen from excision biopsy shows recurrent invasive ductal carcinoma (arrows) in the fat tissue.

View larger version (145K): [in a new window]   Figure 6a. Recurrent carcinoma in a 45-year-old woman who had undergone left modified radical mastectomy 44 months prior to US for a palpable lesion in the left supraclavicular area. (a, b) Transverse (a) and sagittal (b) US images show well-defined ovoid hypoechoic nodules (arrows) in the left supraclavicular area. (c) Photomicrograph (original magnification, x40; hematoxylin-eosin stain) of a specimen from excision biopsy shows enlarged lymph nodes with a malignant cellular infiltrate (arrows).

View larger version (146K): [in a new window]   Figure 6b. Recurrent carcinoma in a 45-year-old woman who had undergone left modified radical mastectomy 44 months prior to US for a palpable lesion in the left supraclavicular area. (a, b) Transverse (a) and sagittal (b) US images show well-defined ovoid hypoechoic nodules (arrows) in the left supraclavicular area. (c) Photomicrograph (original magnification, x40; hematoxylin-eosin stain) of a specimen from excision biopsy shows enlarged lymph nodes with a malignant cellular infiltrate (arrows).

View larger version (157K): [in a new window]   Figure 6c. Recurrent carcinoma in a 45-year-old woman who had undergone left modified radical mastectomy 44 months prior to US for a palpable lesion in the left supraclavicular area. (a, b) Transverse (a) and sagittal (b) US images show well-defined ovoid hypoechoic nodules (arrows) in the left supraclavicular area. (c) Photomicrograph (original magnification, x40; hematoxylin-eosin stain) of a specimen from excision biopsy shows enlarged lymph nodes with a malignant cellular infiltrate (arrows).

View larger version (71K): [in a new window]   Figure 7a. Local recurrence of interpectoral metastatic lymphadenopathy (metastatic Rotter node) with extranodal extension in a 45-year-old woman who had undergone modified radical mastectomy of the right breast 5 years prior to US for left axillary lymphadenopathy detected at chest CT. (a) Transverse image from chest CT shows a soft-tissue-density nodule (arrow) in the posterior portion of the right pectoralis major muscle. The right pectoralis minor muscle is not depicted because it was removed at modified radical mastectomy. P = left pectoralis minor muscle. (b) Transverse US image of the chest wall shows a well-defined ovoid hypoechoic nodule (arrows) in the right pectoralis major muscle. (c) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) of a specimen from excision biopsy shows recurrent invasive ductal carcinoma in the fibromuscular tissue. (d, e) US images of the parasternal area show another ill-defined irregular hypoechoic nodule (arrows) that encases the internal mammary vessel (arrowhead in e). (f) Corresponding transverse chest CT image shows an ill-defined well-enhanced lesion (arrows) that encases the right internal mammary vessel (arrowhead) at the same level as shown in e. The radiologic diagnosis was confirmed at US-guided fine needle aspiration biopsy.

View larger version (143K): [in a new window]   Figure 7b. Local recurrence of interpectoral metastatic lymphadenopathy (metastatic Rotter node) with extranodal extension in a 45-year-old woman who had undergone modified radical mastectomy of the right breast 5 years prior to US for left axillary lymphadenopathy detected at chest CT. (a) Transverse image from chest CT shows a soft-tissue-density nodule (arrow) in the posterior portion of the right pectoralis major muscle. The right pectoralis minor muscle is not depicted because it was removed at modified radical mastectomy. P = left pectoralis minor muscle. (b) Transverse US image of the chest wall shows a well-defined ovoid hypoechoic nodule (arrows) in the right pectoralis major muscle. (c) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) of a specimen from excision biopsy shows recurrent invasive ductal carcinoma in the fibromuscular tissue. (d, e) US images of the parasternal area show another ill-defined irregular hypoechoic nodule (arrows) that encases the internal mammary vessel (arrowhead in e). (f) Corresponding transverse chest CT image shows an ill-defined well-enhanced lesion (arrows) that encases the right internal mammary vessel (arrowhead) at the same level as shown in e. The radiologic diagnosis was confirmed at US-guided fine needle aspiration biopsy.

View larger version (135K): [in a new window]   Figure 7c. Local recurrence of interpectoral metastatic lymphadenopathy (metastatic Rotter node) with extranodal extension in a 45-year-old woman who had undergone modified radical mastectomy of the right breast 5 years prior to US for left axillary lymphadenopathy detected at chest CT. (a) Transverse image from chest CT shows a soft-tissue-density nodule (arrow) in the posterior portion of the right pectoralis major muscle. The right pectoralis minor muscle is not depicted because it was removed at modified radical mastectomy. P = left pectoralis minor muscle. (b) Transverse US image of the chest wall shows a well-defined ovoid hypoechoic nodule (arrows) in the right pectoralis major muscle. (c) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) of a specimen from excision biopsy shows recurrent invasive ductal carcinoma in the fibromuscular tissue. (d, e) US images of the parasternal area show another ill-defined irregular hypoechoic nodule (arrows) that encases the internal mammary vessel (arrowhead in e). (f) Corresponding transverse chest CT image shows an ill-defined well-enhanced lesion (arrows) that encases the right internal mammary vessel (arrowhead) at the same level as shown in e. The radiologic diagnosis was confirmed at US-guided fine needle aspiration biopsy.

View larger version (137K): [in a new window]   Figure 7d. Local recurrence of interpectoral metastatic lymphadenopathy (metastatic Rotter node) with extranodal extension in a 45-year-old woman who had undergone modified radical mastectomy of the right breast 5 years prior to US for left axillary lymphadenopathy detected at chest CT. (a) Transverse image from chest CT shows a soft-tissue-density nodule (arrow) in the posterior portion of the right pectoralis major muscle. The right pectoralis minor muscle is not depicted because it was removed at modified radical mastectomy. P = left pectoralis minor muscle. (b) Transverse US image of the chest wall shows a well-defined ovoid hypoechoic nodule (arrows) in the right pectoralis major muscle. (c) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) of a specimen from excision biopsy shows recurrent invasive ductal carcinoma in the fibromuscular tissue. (d, e) US images of the parasternal area show another ill-defined irregular hypoechoic nodule (arrows) that encases the internal mammary vessel (arrowhead in e). (f) Corresponding transverse chest CT image shows an ill-defined well-enhanced lesion (arrows) that encases the right internal mammary vessel (arrowhead) at the same level as shown in e. The radiologic diagnosis was confirmed at US-guided fine needle aspiration biopsy.

View larger version (163K): [in a new window]   Figure 7e. Local recurrence of interpectoral metastatic lymphadenopathy (metastatic Rotter node) with extranodal extension in a 45-year-old woman who had undergone modified radical mastectomy of the right breast 5 years prior to US for left axillary lymphadenopathy detected at chest CT. (a) Transverse image from chest CT shows a soft-tissue-density nodule (arrow) in the posterior portion of the right pectoralis major muscle. The right pectoralis minor muscle is not depicted because it was removed at modified radical mastectomy. P = left pectoralis minor muscle. (b) Transverse US image of the chest wall shows a well-defined ovoid hypoechoic nodule (arrows) in the right pectoralis major muscle. (c) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) of a specimen from excision biopsy shows recurrent invasive ductal carcinoma in the fibromuscular tissue. (d, e) US images of the parasternal area show another ill-defined irregular hypoechoic nodule (arrows) that encases the internal mammary vessel (arrowhead in e). (f) Corresponding transverse chest CT image shows an ill-defined well-enhanced lesion (arrows) that encases the right internal mammary vessel (arrowhead) at the same level as shown in e. The radiologic diagnosis was confirmed at US-guided fine needle aspiration biopsy.

View larger version (68K): [in a new window]   Figure 7f. Local recurrence of interpectoral metastatic lymphadenopathy (metastatic Rotter node) with extranodal extension in a 45-year-old woman who had undergone modified radical mastectomy of the right breast 5 years prior to US for left axillary lymphadenopathy detected at chest CT. (a) Transverse image from chest CT shows a soft-tissue-density nodule (arrow) in the posterior portion of the right pectoralis major muscle. The right pectoralis minor muscle is not depicted because it was removed at modified radical mastectomy. P = left pectoralis minor muscle. (b) Transverse US image of the chest wall shows a well-defined ovoid hypoechoic nodule (arrows) in the right pectoralis major muscle. (c) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) of a specimen from excision biopsy shows recurrent invasive ductal carcinoma in the fibromuscular tissue. (d, e) US images of the parasternal area show another ill-defined irregular hypoechoic nodule (arrows) that encases the internal mammary vessel (arrowhead in e). (f) Corresponding transverse chest CT image shows an ill-defined well-enhanced lesion (arrows) that encases the right internal mammary vessel (arrowhead) at the same level as shown in e. The radiologic diagnosis was confirmed at US-guided fine needle aspiration biopsy.

View larger version (136K): [in a new window]   Figure 8a. Metastatic carcinoma of the interpectoral lymph node in a 55-year-old woman 4 years after left modified radical mastectomy. Transverse (a) and sagittal (b) US images of the chest wall show a well-defined ovoid hypoechoic nodule (arrows) in the interpectoral area. The radiologic diagnosis was confirmed at US-guided fine needle aspiration biopsy and excision biopsy.

View larger version (135K): [in a new window]   Figure 8b. Metastatic carcinoma of the interpectoral lymph node in a 55-year-old woman 4 years after left modified radical mastectomy. Transverse (a) and sagittal (b) US images of the chest wall show a well-defined ovoid hypoechoic nodule (arrows) in the interpectoral area. The radiologic diagnosis was confirmed at US-guided fine needle aspiration biopsy and excision biopsy.

View larger version (169K): [in a new window]   Figure 9a. Metastatic lymphadenopathy in the left supraclavicular area in a 44-year-old woman who had undergone left modified radical mastectomy 1 year prior to US. (a, b) Transverse (a) and sagittal (b) US images show a well-defined ovoid hypoechoic nodule (arrows) in the left parasternal area. (c) Transverse CT image shows enlarged lymph nodes (arrows) in the left internal mammary chain.

View larger version (148K): [in a new window]   Figure 9b. Metastatic lymphadenopathy in the left supraclavicular area in a 44-year-old woman who had undergone left modified radical mastectomy 1 year prior to US. (a, b) Transverse (a) and sagittal (b) US images show a well-defined ovoid hypoechoic nodule (arrows) in the left parasternal area. (c) Transverse CT image shows enlarged lymph nodes (arrows) in the left internal mammary chain.

View larger version (60K): [in a new window]   Figure 9c. Metastatic lymphadenopathy in the left supraclavicular area in a 44-year-old woman who had undergone left modified radical mastectomy 1 year prior to US. (a, b) Transverse (a) and sagittal (b) US images show a well-defined ovoid hypoechoic nodule (arrows) in the left parasternal area. (c) Transverse CT image shows enlarged lymph nodes (arrows) in the left internal mammary chain.

View larger version (123K): [in a new window]   Figure 10a. Bone metastases in a 36-year-old woman who had undergone right modified radical mastectomy 1 year prior to US for a palpable lesion in the left breast. (a, b) Transverse (a) and sagittal (b) US images show an ill-defined irregular heterogeneous hypoechoic mass with a disrupted margin (arrows) in a rib. (c) Bone scintigram shows multiple areas of radionuclide uptake in the ribs and spine, findings suggestive of diffuse bone metastases.

View larger version (124K): [in a new window]   Figure 10b. Bone metastases in a 36-year-old woman who had undergone right modified radical mastectomy 1 year prior to US for a palpable lesion in the left breast. (a, b) Transverse (a) and sagittal (b) US images show an ill-defined irregular heterogeneous hypoechoic mass with a disrupted margin (arrows) in a rib. (c) Bone scintigram shows multiple areas of radionuclide uptake in the ribs and spine, findings suggestive of diffuse bone metastases.

View larger version (97K): [in a new window]   Figure 10c. Bone metastases in a 36-year-old woman who had undergone right modified radical mastectomy 1 year prior to US for a palpable lesion in the left breast. (a, b) Transverse (a) and sagittal (b) US images show an ill-defined irregular heterogeneous hypoechoic mass with a disrupted margin (arrows) in a rib. (c) Bone scintigram shows multiple areas of radionuclide uptake in the ribs and spine, findings suggestive of diffuse bone metastases.