A 49-year-old woman presented with arm pain for five days. The pain was located in the right armpit and sensitive to touch. The patient also reported bilateral ear pain. There were no chills, fevers, or night sweats. The patient had a normal screening mammogram five months prior. Her family history was significant for her mother with breast cancer and her father with gastric cancer. Socially, she had two cats. On physical examination, there was a painful mass below the right armpit with no overlying skin lesions. Because of the location of the mass and the family history of breast cancer, a repeat mammogram and an ultrasound were recommended. The imaging results were remarkable for a morphologically abnormal right axillary lymph node measuring 31 mm in diameter (Figure ). Ultrasound-guided biopsy was performed, and the surgical pathology exam results were consistent with cat scratch lymphadenopathy. Flow cytometry revealed no detectable monoclonal B cells or immunophenotypically aberrant T cells, which diminished the concern for malignancy. Serology was not available for this case.
A 25-year-old male patient with no significant past medical history presented with a three-day history of a tender mass in the right axilla along with fevers. The patient did not report any night sweats and weight loss. The mass showed no signs of drainage or infection. His physical examination revealed a 3 x 5 cm mobile, soft and non-nodular mass in the right axilla. An ultrasound of the right axilla showed a fluid-filled mass, which was concerning for an abscess. A needle aspiration was attempted without success; therefore, a referral to breast imaging clinic for a diagnostic ultrasound of the mass was initiated. Targeted ultrasound showed axillary lymphadenopathy at the site of the clinically palpable mass (Figure ). Ultrasound-guided biopsy was performed, and pathology revealed suppurative granulomatous lymphadenitis suggestive of CSD. Serology was not available for this case.