Lymphadenopathy after BNT162b2 Covid-19 Vaccine: Preliminary Ultrasound Findings

Granata, Vincenza; Fusco, Roberta; Setola, Sergio Venanzio; Galdiero, Roberta; Picone, Carmine; Izzo, Francesco; D’Aniello, R.; Miele, Vittorio; Grassi, Roberta; Grassi, Roberto; Petrillo, Antonella

doi:10.3390/biology10030214

Cited by 45 publications

(54 citation statements)

References 32 publications

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“…A paper by Granata et al, describing a population of 18 patients that received the Pfizer vaccine, found that 43.1% of lymph nodes showed eccentric cortical thickening with a wide echogenic hilum and oval shape, and 32.8% of lymph nodes showed asymmetric eccentric cortical thickening with a wide echogenic hilum and oval shape. A total of 17.2% of lymph nodes showed concentric cortical thickening with a reduction in the width of the echogenic hilum and oval shape, and 6.9% showed a huge reduction in and displacement of the echogenic hilum and a round or oval shape [14]. These results from the current literature demonstrate the heterogeneity of US features that can be found after COVID-19 vaccines and that there can be patterns that mimic malignant lymph nodes.…”

Section: Discussionmentioning

confidence: 57%

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Lymphadenopathy after the Anti-COVID-19 Vaccine: Multiparametric Ultrasound Findings

Cocco

Pizzi

Fabiani

et al. 2021

Biology

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Background: Post-anti-COVID-19 vaccine lymphadenopathy has recently been described in the literature. In this study, we investigated the multiparametric US findings of patients with post-vaccine lymphadenopathy and compared these findings among different anti-COVID-19 vaccines. Methods: We retrospectively evaluated 24 patients who underwent US between January and May 2021 due to post-anti-COVID-19 lymphadenopathy. The presence, size, location, number, morphology, cortex-hilum, superb microvascular imaging (SMI) and elastosonography of lymph nodes were assessed. Descriptive statistics were calculated and differences among anti-COVID-19 vaccines were analyzed using the Kruskal–Wallis test. A p-value ≤ 0.05 was considered statistically significant. Results: Sixty-six nodes were assessed. They were axillary (mean 1.6 cm ± 0.16) in 11 patients (45.8%) and supraclavicular (mean 0.9 cm ± 0.19) in 13 patients (54.2%). In 20 patients (83.3%), the number of nodes was ≤3. Prevalent US features included oval morphology (18, 75%), asymmetric cortex with hilum evidence (9, 37.5%), central and peripheral vascular signals (12, 50%) at SMI and elastosonography patterns similar to the surrounding tissue (15, 71.4%). No significant differences among the three anti-COVID-19 vaccines were observed (p > 0.05). Conclusions: Anti-COVID-19 vaccines may present lymphadenopathy with “worrisome” US features regarding size, shape, morphology, cortex-hilum, SMI and elastosonography. An awareness of the patient’s history and US findings may help in the early recognition of this clinical scenario and in the appropriate selection of patients for a short-term US follow-up.

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Section: Discussionmentioning

confidence: 57%

“…Following the recent approval of the US Food and Drug Administration (FDA) and the rollout of anti-COVID-19 vaccines, there were several cases of lymphadenopathy. Moreover, recent articles have reported cases of unilateral axillary and supraclavicular adenopathy [8][9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Lymphadenopathy after the Anti-COVID-19 Vaccine: Multiparametric Ultrasound Findings

Cocco

Pizzi

Fabiani

et al. 2021

Biology

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“…Of these, 27 were excluded, most commonly because they were small PET-CT scan studies (n=17) or did not report the minimum amount of data (n=9). This left 15 studies eligible for inclusion [ 16 , 17 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ] ( Fig.1 , Table 1 ). These studies included 2057 patients, with a sample size ranging from 1 to 728, and of those patients, 737 had vaccine-related lymphadenopathy.…”

Section: Resultsmentioning

confidence: 99%

“…Even though palpable adenopathy was still persistent in 7 patients (35%) at the end of the reported follow-up (average 21 days, range 7-32 days), all showed signs of clinical improvement [ 30 ]. Other studies reported an average symptom duration between 7.1 and 26.5 days [ 25 , 26 ]. At the time of the follow-up appointment, a lymph node biopsy should be considered for patients with no signs of clinical improvement.…”

Section: Discussionmentioning

confidence: 99%

Regional lymphadenopathy following COVID-19 vaccination: Literature review and considerations for patient management in breast cancer care

Garreffa

Hamad

O’Sullivan

et al. 2021

European Journal of Cancer

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Purpose Over 1 billion doses of COVID-19 vaccines have been already administered across the US, the UK and the EU at the time of writing. Furthermore, 1.82 million of booster doses have been administered in the US since 13 th August, and similar booster programmes are currently planned or under consideration in the UK and the EU beginning in the autumn of 2021. Early reports showed an association between vaccine administration and the development of ipsilateral axillary and supraclavicular lymphadenopathy which could interfere with the diagnosis, treatment and follow-up of breast cancer patients. In this paper, we review the available evidence on vaccine-related lymphadenopathy, and we discuss the clinical implications of same on breast cancer diagnosis and management. Methods A literature search was performed - PubMed, Ovid Medline, Scopus, CINHAL, Springer Nature, Sciencedirect, Academic Search Premiere and the Directory of Open Access Journals were searched for articles reporting on regional palpable or image-detected lymphadenopathy following COVID-19 vaccination. Separately, we compiled a series of case studies from the University Hospitals of Derby and Burton, UK and the Mayo Clinic in Minnesota, USA to illustrate the impact that regional lymphadenopathy post-COVID-19 vaccination can have on the diagnosis and management of patients being seen in diagnostic and therapeutic breast clinics. Results From the literature search 15 studies met the inclusion criteria (n = 2057 patients, 737 with lymphadenopathy). The incidence of lymphadenopathy ranged between 14.5% and 53% and persisted for >6 weeks in 29% of patients. Conclusions Clinicians managing breast cancer patients should be aware that the COVID-19 vaccination may result in regional lymphadenopathy in a significant number of patients which can result in unnecessary investigations, treatment and increased patient anxiety. An accurate COVID-19 vaccination history should be collected from all patients where regional lymphadenopathy is a clinical &/or an imaging finding and then combined with clinical judgment when managing individual cases.

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“…Several previous studies [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ] have described the main CT signs of COVID-19, summarized as GGO, crazy-paving pattern, and consolidation. Several methods of disease extent quantification at chest CT using machine learning and AI tools have been proposed, including the extent of emphysema, GGO, and consolidation [ 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ]. Few studies have investigated the changes in CT findings associated with COVID-19 pneumonia in the follow-up, quantifying the evolution and the absorption of the abnormalities visible on CT using a computer automatic aided tool.…”

Section: Discussionmentioning

confidence: 99%

Evolution of CT Findings and Lung Residue in Patients with COVID-19 Pneumonia: Quantitative Analysis of the Disease with a Computer Automatic Tool

Grassi

Cappabianca

Urraro

et al. 2021

JPM

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Purpose: the purpose of this study was to assess the evolution of computed tomography (CT) findings and lung residue in patients with COVID-19 pneumonia, via quantified evaluation of the disease, using a computer aided tool. Materials and methods: we retrospectively evaluated 341 CT examinations of 140 patients (68 years of median age) infected with COVID-19 (confirmed by real-time reverse transcriptase polymerase chain reaction (RT-PCR)), who were hospitalized, and who received clinical and CT examinations. All CTs were evaluated by two expert radiologists, in consensus, at the same reading session, using a computer-aided tool for quantification of the pulmonary disease. The parameters obtained using the computer tool included the healthy residual parenchyma, ground glass opacity, consolidation, and total lung volume. Results: statistically significant differences (p value ≤ 0.05) were found among quantified volumes of healthy residual parenchyma, ground glass opacity (GGO), consolidation, and total lung volume, considering different clinical conditions (stable, improved, and worsened). Statistically significant differences were found among quantified volumes for healthy residual parenchyma, GGO, and consolidation (p value ≤ 0.05) between dead patients and discharged patients. CT was not performed on cadavers; the death was an outcome, which was retrospectively included to differentiate findings of patients who survived vs. patients who died during hospitalization. Among discharged patients, complete disease resolutions on CT scans were observed in 62/129 patients with lung disease involvement ≤5%; lung disease involvement from 5% to 15% was found in 40/129 patients, while 27/129 patients had lung disease involvement between 16 and 30%. Moreover, 8–21 days (after hospital admission) was an “advanced period” with the most severe lung disease involvement. After the extent of involvement started to decrease—particularly after 21 days—the absorption was more obvious. Conclusions: a complete disease resolution on chest CT scans was observed in 48.1% of discharged patients using a computer-aided tool to quantify the GGO and consolidation volumes; after 16 days of hospital admission, the abnormalities identified by chest CT began to improve; in particular, the absorption was more obvious after 21 days.

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Lymphadenopathy after BNT162b2 Covid-19 Vaccine: Preliminary Ultrasound Findings

Cited by 45 publications

References 32 publications

Lymphadenopathy after the Anti-COVID-19 Vaccine: Multiparametric Ultrasound Findings

Lymphadenopathy after the Anti-COVID-19 Vaccine: Multiparametric Ultrasound Findings

Regional lymphadenopathy following COVID-19 vaccination: Literature review and considerations for patient management in breast cancer care

Evolution of CT Findings and Lung Residue in Patients with COVID-19 Pneumonia: Quantitative Analysis of the Disease with a Computer Automatic Tool

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