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In this case, we have a 38 year old female presenting with bilateral

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axillary palpable findings, which have been present for some time, and she

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comes in for further imaging evaluation. Now, we'll start with, again,

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looking at our overall full field CC and MLO views. In this patient,

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she had no prior history of having any imaging, so nothing to compare

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to, so we'll get all the full field views as well.

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We have pretty good image quality, I would say. The pectoralis muscles do

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not come down all the way to the level of the nipple, so

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we would hope to get even a little more pectoralis muscle in these

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images. Now, it's probably okay, probably adequate for what we need for

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today's exam, but you might wonder or ask your technologist about this,

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potentially. Sometimes patients are more difficult to pull on, particularly

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those patients with more dense breasts. So, let me first adjust the CC views

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for us. In the CC views, the SM views here,

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we notice that there's no BB marker in the CC, as far as

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we can tell. Now, we would expect it in the lateral aspect of

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the breast, because we know that these were axillary findings, but we also

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sort of don't expect to see them, because

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it's very difficult to get axillary tissue on a CC view. Now, our technologist

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did try XCCL views in this case, and again, we still don't see

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any palpable marker on the CC view. Now, we'll look at the rest

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of the breast, just to make sure we're not missing anything else,

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but we don't see anything abnormal in this case. Technologists will do spot

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compression views over the palpable abnormality. In this case, they were

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able to get the axillary palpable findings very high up in the axilla. We

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can see our markers here and here. And if we switch over to

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the DVT views, we can scroll through the imaging stack to take a

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closer look. Now, of course, in this case, we'll start in the lateral

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aspect and move immediately. Our palpable BB marker is coming into view.

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And underlying, we see some wispy fibroglandular tissue, which is directly

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underlying that marker. And then we also can see some normal appearing axillary

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lymph nodes. Now, it's a little bit unclear whether she's feeling maybe

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that axillary tissue or the lymph nodes, but it's something we can ask

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her as a technologist to confirm with the patient.

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Similarly, on the left side, we see the palpable BB marker is just

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at the margin of our spot compression paddle. And underline, we again see

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this sort of normal wispy fibroglandular tissue, and then again, some normal

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left axillary lymph nodes. Now, in this case, the patient did go on

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to ultrasound. She had bilateral axillary ultrasound, which showed both

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of these findings. Again, some normal axillary glandular tissue, some normal

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appearing lymph nodes, all looked well. It's very likely that she's feeling

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a little bit of this axillary tissue, and for whatever reason,

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just happened to feel it at that point.

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But she can be reassured and sent back to her

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referring provider and just undergo routine screening, preferably at age

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40.