0:01

Our next case is a 41-year-old woman with a

0:03

recent diagnosis of right breast cancer, and her

0:07

MRI was for evaluation of the extent of disease, and

0:10

another important fact was that she had a recent

0:13

COVID-19 vaccine administered to her left arm.

0:17

So, taking a look at this patient,

0:21

this is the T1 non-fat-saturated

0:23

image, which I like for the evaluation of

0:30

lymph nodes, and this patient was scanned

0:33

with her just incidentally scanned with

0:36

her arms down, so you can see her pectoralis

0:38

muscle kind of goes out here laterally.

0:41

When the arms are up, this forms more of

0:43

a triangle, and you don't see this lateral

0:46

extent, so she was scanned with her arms down.

0:49

And we can see, starting from the lower axilla,

0:56

there are a few lymph nodes like this one.

0:59

So there's a little C-shaped

1:01

lymph node with central fat.

1:04

So, level one lymph node,

1:08

and then going up, now we're

1:11

getting posterior to the pectoralis.

1:17

We have a couple of lymph nodes here that

1:20

are high up, and there's even one, it's

1:25

hard to see because it's right at the top

1:26

of our scan, but there's one that's clearly

1:29

medial to the pectoralis minor, and that

1:32

would be considered a level three lymph node.

1:33

So, I just wanted to show you those.

1:36

And this is a patient who did receive her COVID

1:40

vaccine on the left side, which is probably

1:43

why her lymph nodes are a little bit more

1:45

prominent when you compare it to the right side.

1:47

35 00:01:48,320 --> 00:01:51,450 She really doesn't have prominent

1:51

lymph nodes on the right side.

1:54

We can also look at these lymph nodes on post.

1:58

Well, you can look at them

1:59

a number of different ways.

2:02

We can see them on STIR images, all these

2:05

little bright dots here are lymph nodes.

2:09

There's that larger C-shaped one, and

2:13

these kind of larger ones behind the

2:17

pect minor and medial to the pect minor.

2:21

And you can look at them on source

2:26

or post-contrast images. There's post-

2:31

contrast image showing a level one

2:34

lymph node, and then kind of going up,

2:41

there's that row that's posterior

2:43

to the pectoralis minor.