66-year-old with multicentric left breast cancer with metastatic left axillary lymph node, status post neoadjuvant chemotherapy. Repeat mammogram and ultrasound for left axilla to look for a marker clip. MLO, exaggerated CC, and spot compression views of the left breast (axilla) were performed digitally. Previously seen enlarged lymph node in the left axilla has become smaller, measuring 7 mm. Hydromark clip is again identified within this lymph node.Focused ultrasound was performed for the left axilla with 12-5 MHz transducer. Within a normal appearing lymph node, there is a hyperechoic material, likely a metallic clip. There is no hypoechoic portion, which is usually seen for Hydromark clip, surrounding this metallic clip. A BB marker was placed on the skin over the metallic clip, and MLO view of mammogram was performed. BB marker is the same level of the lymph node with Hydromark clip, confirming the metallic clip seen on the ultrasound study is a metallic component of the Hydromark clip.
Successful visualization of the Hydromark clip by ultrasound within the left axillary lymph node, which has become smaller after neoadjuvant chemotherapy. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.