Ms. Elizabeth Kirkland is a 75 year old female with bilateral lumpectomies for breast cancer (left breast - 2011 for IDC, right breast - 2014 for DCIS) followed by radiation and hormonal therapy. Bilateral breast scars. Personal history of oophorectomy. She presents for ultrasound evaluation of the lymph nodes in her left lower neck palpated by her physician. She states that she is having symptoms of infection currently. On physical examination, no discrete large lymph node is palpated in her left lower neck.A targeted left neck ultrasound was performed for the palpable area of concern designated by patient. In the lower neck, adjacent to the left common carotid artery, there are 4-5 prominent lymph nodes with diffuse cortical thickening. The largest one measuring up to 1.9 cm. Ultrasound of the right lower neck is also performed comparison. There are 2-3 lymph nodes with cortical thickening measuring up to 1 cm.
Bilateral prominent lymph nodes in the lower neck with diffuse cortical thickening, left greater than right. These are likely reactive lymph nodes given patient's current infectious status. Patient is going to have palpation guided fine needle aspiration due to her personal history of breast cancer. If FNA confirms it to be benign, clinical follow up is recommended. Alternatively, patient can be followed up with ultrasound in one month. Results and recommendations were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).