Question:

What is the characteristic appearance of silicone lymphadenitis on ultrasound?
1. Markedly hyperechoic lymph nodes with posterior acoustic shadowing.
2. Markedly hypoechoic lymph nodes with posterior acoustic enhancement.
3. Reniform shape with preservation of fatty hilum.
4. Smooth thickened nodal cortex with fatty hilum.
5. Eccentrically thickened cortex with disruption/displacement of fatty hilum.





Answer:

The correct answer for the question "What is the characteristic appearance of silicone lymphadenitis on ultrasound?" is:

1. Markedly hyperechoic lymph nodes with posterior acoustic shadowing.



Explanation
1. Typical appearance of a silicone laden lymph node is heterogeneously hyperechoic with dirty shadowing.  Initially subtle, ill-defined, incoherent posterior acoustic shadowing arising from the lymph node mediastinum. As amount of silicone gel increases, the hilum becomes more hyperechoic, and shadowing assumes a more classic "snowstorm "appearance. Eventually, even the cortex becomes hyperechoic, giving an overall snowstorm appearance of the lymph node.

2. Such a nodal morphology would suggest an abnormality likely warranting tissue sampling.  This `cystic` appearance is worrisome for malignancy/metastasis and not typical for silicone adenitis which has characteristic dirty shadowing compatible with benign process.

3. This would indicate a normal axillary nodal morphology unless silicone rupture and spread to nodes is extremely early, an unlikely appearance of axillary nodal silicone adenitis.

4. This appearance is typical of a reactive node especially when bilateral and symmetric.  Clinical correlation for causes of reactive adenopathy (ie immunosuppression/HIV, autoimmune/connective tissue disorders) is usually recommended, occasionally close imaging follow up is warranted.

5. This appearance is also worrisome for malignancy especially in light of eccentric cortical thickening and mass effect on the hilum. Tissue sampling would be warranted in this case as well.



From the manuscript:
Contralateral Intramammary Silicone Lymphadenitis in a Patient with an Intact Standard Dual-Lumen Breast Implant in the Opposite Reconstructed Breast
Radiology Case. 2013 Nov; 7(11):24-31


This article belongs to the Mamms section.




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From the manuscript

Contralateral Intramammary Silicone Lymphadenitis in a Patient with an Intact Standard Dual-Lumen Breast Implant in the Opposite Reconstructed Breast

Free full text article: Contralateral Intramammary Silicone Lymphadenitis in a Patient with an Intact Standard Dual-Lumen Breast Implant in the Opposite Reconstructed Breast

Abstract
Silicone lymphadenopathy is a recognized complication of silicone gel implant rupture; the ipsilateral axillary lymph nodes are most commonly involved. We report imaging findings on a range of different imaging modalities and biopsy results in a case of biopsy-proven silicone lymphadenitis involving contralateral intramammary and axillary lymph nodes in a patient with an intact standard dual-lumen breast implant in the opposite reconstructed breast. This case demonstrates that in a patient with disrupted lymph drainage due to prior mastectomy and axillary node dissection for breast cancer treatment, silicone particles can migrate in a retrograde fashion via the ipsilateral internal mammary lymph nodes and reach not only the contralateral axilla but also the outer quadrants of the contralateral breast, even in the presence of an intact breast implant.






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