Bilateral axillary hypoechoic nodes consider lymph nodes as imaging findings mostly suggest lymph node enlargement, and common causes include lymphadenitis, lymph node metastasis, lymphoma, reactive hyperplasia and other diseases. 1. Lymphadenitis: such as upper limb, chest wall and other infections may spread to the axilla, thus causing inflammation of axillary lymph nodes, resulting in their enlargement, which is manifested as hypoechoic nodules on imaging examination. Patients may also be accompanied by local skin redness, pressure pain, fever, chills and other symptoms. 2. Lymph node metastasis: When the cancer cells metastasize to bilateral axillae of malignant tumors such as breast cancer, the lymph nodes in axillae may be enlarged, and the imaging suggests hypoechoic nodes, and the local skin color of the patient is relatively normal, not accompanied by pain. 3. Lymphoma: belongs to malignant tumor of blood system, which may manifest as multiple painless lymph node enlargement in the whole body, such as enlargement of lymph nodes in the neck, bilateral axilla, supraclavicular lymph nodes, which also manifests as hypoechoic nodes, and the patient may be accompanied by night sweating, fever, sternal pressure pain, itchy skin and other symptoms. 4. Reactive hyperplasia: common in serum sickness and serum sickness-like reaction, systemic lupus erythematosus rheumatism, etc. Whether the condition is serious or not should be analyzed with the patient’s individual situation. It is suggested that patients should consult the doctor in time, improve the pathological biopsy, blood routine and other tests to make a clear diagnosis, and actively treat the cause to avoid delaying the condition.