Female, 34 years old, with history of p53 mutation, Li-Fraumeni syndrome, bilateral breast cancer with increasing right sided level 1 lymph nodes. A cluster of small lymph nodes is evident at level Ib bilaterally. None of these is large enough to meet imaging criteria for pathologic enlargement. However, the cluster on the right does correlate with increased FDG uptake on prior PET scanning.Multiple prominent cervical lymph nodes are identified elsewhere on both sides of the neck including at level II bilaterally and level III on the left. For reference, one of the left level II nodes measures 15 x 14 mm (image 22 series 8). The aggregate at level III contains foci of susceptibility which may reflect calcifications or surgical clips. Although the CT portion of the prior PET/CT is inadequate for accurate comparison, these nodes do seem to have been present on that exam.The aerodigestive tract is unremarkable. The salivary glands and thyroid are free of suspicious focal lesions. The marrow signal characteristics are unremarkable.
A cluster of small lymph nodes is evident at level Ib on the right. Although none of these reaches imaging criteria for pathologic enlargement, the cluster does correlate with increased FDG uptake on a prior PET scan.Pathologically enlarged lymph nodes and nodal aggregates are detected elsewhere, particularly in the left neck, but these were likely present on prior PET/CT where they showed only mild FDG uptake. 