Bilateral lymphadenopathies on mammograms: a case of mixed connective tissue disease and psoriatic arthropathy

Axillary lymphadenopathy is defined as abnormality (e.g., increase in size or density) of lymph nodes in the armpit, caused by malignant diseases such as metastases (mainly from primary breast cancer), lymphoma, or leukaemia as well as benign conditions such as infectious or autoimmune systemic diseases. Appropriate imaging and pathological examinations on needle samples, together with accurate clinical correlation are needed for a correct diagnosis and management. Herein, we report a case of a 47-year-old female presented at our department of radiology for her annual mammographic screening. Mammography demonstrated multiple bilateral, enlarged, although benign-appearing axillary lymph nodes. While both breasts showed no sign of malignancy on mammograms, the lymphadenopathies suggested a potential underlying inflammatory process. Previous mammography performed five years before did not present any lymphadenopathy. The patient, recalled for additional breast and axillary ultrasound and for clinical correlation, reported that she had been suffering for at least four years from an autoimmune systemic disease, mixed connective tissue disease, recently overlapping with psoriatic arthropathy, thus explaining the aetiology of reactive lymph nodes enlargement.