| Minimum axillary protocol | high-frequency linear transducer; side, palpable area, skin, subcutaneous tissue, accessory breast tissue, lymph nodes and vessels when relevant | In breast/oncology context, document the axillary level when possible: lateral to pectoralis minor, posterior to pectoralis minor or medial to pectoralis minor.complete: side, location, morphology and Doppler when indicatedacceptable focused exam: symptomatic area only, with limitation clearly describedincomplete: palpable lump or oncology context without nodal/correlated breast assessmentSource: ACR Appropriateness Criteria Imaging of the Axilla / AIUM-ACR breast ultrasound parameter |
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| Typical normal axillary lymph node | oval or gently lobulated, thin homogeneous cortex, preserved fatty hilum | Cortex thinner than 3 mm with a central echogenic hilum is the most used normal pattern; size alone is less reliable than morphology.consensus normal: cortex <3 mm, preserved hilum, oval shapeborderline: cortex 3-5 mm, diffuse and with preserved hilumconsensus abnormal: absent/replaced hilum, eccentric focal cortex or suspicious rounded shapeSource: Dialani et al. Insights Imaging 2015 / UCLA Radiology / Bedi AJR 2008 |
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| Lymph-node cortex | <3 normal; 3-5 gray zone; >5 suspicious if there is no clear reactive explanation mm | Some studies use 2.3-3 mm thresholds for sensitivity, but this increases false positives. The table therefore keeps isolated thickening with preserved hilum in yellow.normal: <3 mmgray zone: 3–5 mmsuspicious: >5 mm ou espessamento excêntricoSource: Bedi AJR 2008 / Deurloo-Br J Cancer / ECR axillary assessment |
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| Lymph-node shape | long-axis/short-axis ratio ≥2 favors benignity; <2 suggests rounding | Avoid abbreviations in learner-facing reports: write long axis and short axis. Round shape carries more weight when paired with hilum loss or eccentric cortex.oval: ratio ≥2indeterminate: ratio near 2 with preserved hilumrounded: ratio <2 with associated suspicious findingsSource: Axillary lymph node ultrasound reviews / Vassallo criteria |
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| Lymph-node Doppler | hilar/central flow is more reassuring; peripheral, mixed or chaotic flow increases suspicion | Doppler is adjunctive: absent flow does not exclude disease, and hyperemia can be reactive with vaccination, infection or hidradenitis.hilar or absent: compatible if morphology is benignreactive increase: central/hilar in an inflammatory contextperipheral/disorganized: especially with lost hilum or suspicious breast massSource: Axillary node ultrasound morphology reviews |
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| Accessory axillary breast tissue | echotexture similar to breast, may contain cysts, fibroadenoma or malignancy like ordinary breast tissue | If there is a true focal lesion in accessory breast tissue, describe it with the breast lexicon and BI-RADS category according to local context.typical accessory tissue: no focal massprobably benign finding: simple cyst or typical fibroadenomasuspicious lesion: irregular mass, not parallel, suspicious calcifications or skin retractionSource: ACR BI-RADS / axillary mass reviews |
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| Hidradenitis, abscess and axillary skin | dermal thickening, tracts/tunnels, collections, debris and peripheral hyperemia | Ultrasound helps separate lymph node, drainable abscess, skin fistula, epidermal cyst and cellulitis. Gas, deep collection or systemic signs increase urgency.normal skin: no collection or tractinflammatory: thickening, hyperemia or superficial tractcomplicated: drainable abscess, gas, deep collection or immunosuppressionSource: Hidradenitis suppurativa ultrasound reviews / DERMUS |
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