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  Indian J Med Microbiol
 

Figure 9: 31-year-old female with left breast invasive carcinoma and malignant axillary adenopathy. 5 months after neoadjuvant therapy, there was sonographic resolution of the pathologic axillary lymph node. Patient subsequently underwent contrast injection for help with ultrasound localization of the clipped metastatic lymph node. (a) Preprocedure ultrasound image demonstrates a morphologically normal lymph node (arrow) after neoadjuvant therapy. The localization clip is not clearly visualized. (b) Static ultrasound image showing injection of contrast (arrow) into the lymph node. A 1 cc injection of a 1:10 solution of sterile Omnipaque 350 and sterile normal saline using sterile technique and local anesthesia with 1% lidocaine with bicarbonate was slowly injected near the lymph node. The contrast appears hyperechoic (arrow). (c) Postcontrast injection mammogram ML view demonstrates contrast in the region of the confirmed clipped lymph node (arrow). (d) Tomosynthesis images demonstrate the contrast to be in the same plane as the clip (arrow) and in close proximity. The patient was then brought back to the ultrasound suite. (e) Hyperechoic contrast is noted with in the lymph node (arrow). (f) Ultrasound static image demonstrating a seed (arrow) placed within the appropriate lymph node. (g) Postseed placement mammogram demonstrating contrast in the region of the clipped lymph node (arrow) and the seed (arrowhead).

Figure 9: 31-year-old female with left breast invasive carcinoma and malignant axillary adenopathy. 5 months after neoadjuvant therapy, there was sonographic resolution of the pathologic axillary lymph node. Patient subsequently underwent contrast injection for help with ultrasound localization of the clipped metastatic lymph node. (a) Preprocedure ultrasound image demonstrates a morphologically normal lymph node (arrow) after neoadjuvant therapy. The localization clip is not clearly visualized. (b) Static ultrasound image showing injection of contrast (arrow) into the lymph node. A 1 cc injection of a 1:10 solution of sterile Omnipaque 350 and sterile normal saline using sterile technique and local anesthesia with 1% lidocaine with bicarbonate was slowly injected near the lymph node. The contrast appears hyperechoic (arrow). (c) Postcontrast injection mammogram ML view demonstrates contrast in the region of the confirmed clipped lymph node (arrow). (d) Tomosynthesis images demonstrate the contrast to be in the same plane as the clip (arrow) and in close proximity. The patient was then brought back to the ultrasound suite. (e) Hyperechoic contrast is noted with in the lymph node (arrow). (f) Ultrasound static image demonstrating a seed (arrow) placed within the appropriate lymph node. (g) Postseed placement mammogram demonstrating contrast in the region of the clipped lymph node (arrow) and the seed (arrowhead).