Figure 1
Figura 1
Shows an elongated opacity with well defined limits extending from the axillary region.
Breast lymphocele
SectionBreast imaging
Case TypeClinical Cases
AuthorsRakhtawane E, Chedid G, Benismaili M, Khoury R, Le Van An J.C.
Connected authors
65 years, female
Clinical History
History of axillary lymphadenectomy for lymph node metastases. Appearance of a mass.
Imaging Findings
The patient underwent an axillary lymph node dissection for lymph node metastases. Pathology revealed carcinoma but no breast tumor was found.
4 months later a cystic mass was felt.
A mammography and MRI was performed to search for a breast tumor, but showed a large cystic mass.
A control ultrasound was performed 3 months later.
A mammography and MRI was performed to search for a breast tumor, but showed a large cystic mass.
A control ultrasound was performed 3 months later.
Discussion
Lymphocele is a lymphatic collection in the detachment spaces created by the ablation of lymphatic tissue from the drainage surface of a malignant tumour.
It constitutes the most important complication of lymphadenectomy. The formation of this lymphocele is often in connection with the secondary appearance of a chronic lymphoedema.
The incidence has been reported to range from 5% to 35% according to Salmon, and 12% according to Salvat.
Physical examination in seated or upright position is necessary to reveal the swelling, which may remain unsuspected. To detect a small lymphocele, ultrasound is useful within one week after surgery. According to Salmon there is a positive correlation between the incidence of the lymphocele and the quantity of drained fluid, the duration of drainage and the extent of the lymph nodes dissection area, the age of the patient, obesity, arterial hypertension and breast volume. The impact of an anticoagulant treatment by heparine has been reported. According to Flew the volume and duration of the lymphocele are decreased when the patient has no early physiotherapeutic shoulder treatment after surgery. The external postoperative radiotherapy and the tumor staging do not affect the formation of lymphocele. No treatment is recommended when the lymphoceles are quiet or less than 2 cm . For those larger or which are under tension, percutaneous aspiration, or percutaneous drainage should be performed . Spontaneous regression may be up to 15% within several months. Preventive treatment is more effective, Aitken suggested a reduction of the surgical detachment spaces as a real solution to decrease seriously the incidence.
The incidence has been reported to range from 5% to 35% according to Salmon, and 12% according to Salvat.
Physical examination in seated or upright position is necessary to reveal the swelling, which may remain unsuspected. To detect a small lymphocele, ultrasound is useful within one week after surgery. According to Salmon there is a positive correlation between the incidence of the lymphocele and the quantity of drained fluid, the duration of drainage and the extent of the lymph nodes dissection area, the age of the patient, obesity, arterial hypertension and breast volume. The impact of an anticoagulant treatment by heparine has been reported. According to Flew the volume and duration of the lymphocele are decreased when the patient has no early physiotherapeutic shoulder treatment after surgery. The external postoperative radiotherapy and the tumor staging do not affect the formation of lymphocele. No treatment is recommended when the lymphoceles are quiet or less than 2 cm . For those larger or which are under tension, percutaneous aspiration, or percutaneous drainage should be performed . Spontaneous regression may be up to 15% within several months. Preventive treatment is more effective, Aitken suggested a reduction of the surgical detachment spaces as a real solution to decrease seriously the incidence.
Differential Diagnosis List
Breast lymphocele
Final Diagnosis
Breast lymphocele
References
[1]
Salmon RJ, Cody HS, Vedrenne JB, Asselain B, Durand JC, Pilleron JP.
Prevention of postoperative lymphocele after breast amputation.
Presse Med. 1985 Jan 12;14(1):27-9. (PMID: 3155841)
[2]
Flew TJ.
Wound drainage following radical mastectomy: the effect of restriction of shoulder movement.
Br J Surg. 1979 May;66(5):302-5. (PMID: 376029)
[3]
Rauch P, De la Chapelle AL, Meunier A, Luporsi E, Guillemin F.
Axillary lymphoceles after breast cancer surgery. Pathogeny, prevention.
J Chir (Paris). 1996;133(9-10):448-52. (PMID: 9296020)
[4]
Brun JL.
Postoperative lymphoceles and lymphatic fistula in gynecologic and breast neoplasms.
Bull Cancer. 1995 Sep;82(9):711-6. Review. (PMID: 8535029)
[5]
Mann WJ, Vogel F, Patsner B, Chalas E.
Management of lymphocysts after radical gynecologic surgery.
Gynecol Oncol. 1989 May;33(2):248-50. (PMID: 2703185)
Case information
| URL: | https://www.eurorad.org/case/2168 |
| DOI: | 10.1594/EURORAD/CASE.2168 |
| ISSN: | 1563-4086 |
Figure 2
Figura 2
Showing heterogeneous echogenicity of a well circumscribed fluid collection.
Figura 1
Shows an elongated opacity with well defined limits extending from the axillary region.
Figura 2
Showing heterogeneous echogenicity of a well circumscribed fluid collection.
