title: Reverse echelon node and a lymphatic ectasia in the same patient during breast lymphoscintigraphy: the importance of injection and imaging technique.
abstract: Lymphoscintigraphy, along with triangulated patient body marking, can serve as a guide for surgeons during sentinel lymph node harvesting. Unique drainage patterns have been noted, especially with areolar or intradermal based injections, which are becoming increasingly popular. The images lymphoscintigraphy provide have been invaluable in delineating these patterns. The authors present a case that simultaneously illustrates two separate points in the same patient, a reverse echelon node and a lymphatic ectasia. To our knowledge, this combination has never been described in the same patient. Perilesional and areolar-cutaneous junction injections were performed sequentially and generated these patterns that could potentially have resulted in added morbidity and a false-negative sentinel node if not realised before surgery. Lymphoscintigraphy added valuable information in the management of this patient, which can occasionally present with complex patterns of activity during sentinel node harvesting.
authors.affiliation: Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, New York, NY 10029, USA.
authors.forename: S H
authors.initials: SH
authors.lastname: Kim
authors.forename: J
authors.initials: J
authors.lastname: Shim
authors.forename: C K
authors.initials: CK
authors.lastname: Kim
authors.forename: J
authors.initials: J
authors.lastname: Machac
authors.forename: B R
authors.initials: BR
authors.lastname: Krynyckyi
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007267:Injections; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D013671:Technetium Tc 99m Sulfur Colloid
chemical_list: D019275:Radiopharmaceuticals; D013671:Technetium Tc 99m Sulfur Colloid