Identification and description of the axillary web syndrome (AWS) By clinical signs, MRI and US imaging

The Axillary Web Syndrome (AWS)follows surgery for breast neoplasia andconsists of one, or more frequently two orthree, cords of subcutaneous tissue. Cordsoriginate from the axilla, spread to the anteromedialsurface of the arm down to the elbowand then move into the antero-medial aspectof the forearm and sometimes into the root ofthe thumb. The purpose of this study was tocompare two techniques, ultrasound (US) andMagnetic Resonance Imaging (MRI) for theirsensitivity and accuracy in identifying AWScords and to provide insights to the origin ofthis pathology. US examinations wereperformed on fifteen patients using a highfrequency probe (17MHz). We first palpatedand marked the cord with location aided bymaximum abduction. To identify the cord withMRI (1.5 Tesla), a catheter filled with a geldetectable under MRI was placed on the skinat the site of the cord. We found that in someUS cases, the dynamic abduction maneuverwas essential to facilitate detection of thecord. This dynamic method on ultrasoundconfirmed the precise location of the cordeven if it was located deeper in the hypodermisfascia junction. US and MRI images revealedfeatures of the cords and surrounding tissues.Imaging the cords was difficult with either ofthe imaging modalities. However, US seemedto be more efficient than MRI and alloweddynamic evaluation. Overall analysis of ourstudy results supports a lymphatic origin ofthe AWS cord.