Unilateral Lymphadenopathy After COVID-19 Vaccination: A Practical Management Plan for Radiologists Across Specialties

Lehman, Constance D.; D’Alessandro, Helen Anne; Mendoza, Dexter P.; Succi, Marc D.; Kambadakone, Avinash; Lamb, Leslie

doi:10.1016/j.jacr.2021.03.001

Cited by 88 publications

(134 citation statements)

References 23 publications

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“…In patients with cancer history, the vaccine should be administered on the contralateral side of the primary or suspected cancer or in the thigh[ 198 ]. If axillary adenopathy is present on a low-dose CT for lung cancer screening, the “S” modifier should be added on the Lung-RADS reporting system and no further imaging should be pursued[ 199 ]. Based on the Society of Breast Imaging, the presence of unilateral axillary lymphadenopathy should warrant a BI-RADS 0 and prompt further assessment and documentation of the patient’s vaccination history.…”

Section: Cancer Screening Delaysmentioning

confidence: 99%

Imaging in the COVID-19 era: Lessons learned during a pandemic

Sidéris

Nikolakea²,

Karanikola³

et al. 2021

WJR

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The first year of the coronavirus disease 2019 (COVID-19) pandemic has been a year of unprecedented changes, scientific breakthroughs, and controversies. The radiology community has not been spared from the challenges imposed on global healthcare systems. Radiology has played a crucial part in tackling this pandemic, either by demonstrating the manifestations of the virus and guiding patient management, or by safely handling the patients and mitigating transmission within the hospital. Major modifications involving all aspects of daily radiology practice have occurred as a result of the pandemic, including workflow alterations, volume reductions, and strict infection control strategies. Despite the ongoing challenges, considerable knowledge has been gained that will guide future innovations. The aim of this review is to provide the latest evidence on the role of imaging in the diagnosis of the multifaceted manifestations of COVID-19, and to discuss the implications of the pandemic on radiology departments globally, including infection control strategies and delays in cancer screening. Lastly, the promising contribution of artificial intelligence in the COVID-19 pandemic is explored.

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Section: Cancer Screening Delaysmentioning

confidence: 99%

Imaging in the COVID-19 era: Lessons learned during a pandemic

Sidéris

Nikolakea²,

Karanikola³

et al. 2021

WJR

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“…Recently, several case reports on the occurrence of post-COVID 19 vaccination axillary lymphadenopathy were published 4 , 5 , 6 , 7 , 8 . In February 2021, a scientific expert panel published recommendations regarding post vaccination lymphadenopathy for patients undergoing imaging that includes the axillae [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

COVID-19 Vaccination Induced Lymphadenopathy in a Specialized Breast Imaging Clinic in Israel: Analysis of 163 cases

et al. 2021

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Introduction: Following vaccination of Israeli population with Pfizer-BioNTech COVID-19 Vaccine, an unusual increase in axillary-lymphadenopathy was noted. This study assesses the rate and magnitude of this trend from breast-imaging standpoint. Materials and Methods: Participants undergoing breast-imaging, in whom isolated axillary-lymphadenopathy was detected were questioned regarding SARS-CoV-2 vaccine to the ipsilateral arm. Patients’ and imaging characteristics were statistically compared. In order to perform a very short-term follow-up, twelve healthy vaccinated medical staff-members, underwent axillary-ultrasound shortly after the second dose, and follow-up. Results: Axillary-lymphadenopathy attributed to vaccination was found in 163 women undergoing breast-imaging, including BRCA -carriers. During the study, number of detected lymphadenopathies increased by 394% (p=0.00001) in comparison with previous two consecutive years. Mean cortical-thickness of abnormal lymph-nodes after second dose vaccination was 5±2 mm. Longer lymph-node diameter after second vaccination was noted (from 15±5 mm, to 18±6 mm, p=0.005). In the subgroup of medical staff members, following trends were observed: in patients with positive antibodies, lymph-node cortical-thickness was larger than patients with negative serology (p=0.03); lymph-node cortical-thickness decreased in 4-5 weeks follow-up (p=0.007). Lymphadenopathy was evident on mammography in only 49% of cases. Discussion: Vaccine-associated lymphadenopathy is an important phenomenon with great impact on breast-imaging clinic workload. Results suggest the appearance of cortical thickening shortly after both doses. Positive serology is associated with increased lymph-node cortical-thickness. In asymptomatic vaccinated women with ipsilateral axillary-lymphadenopathy as the only abnormal finding, radiological follow-up is probably not indicated. BRCA -carriers, although at higher risk for breast-cancer, should probably receive the same management as average-risk patients.

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“…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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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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Unilateral Lymphadenopathy After COVID-19 Vaccination: A Practical Management Plan for Radiologists Across Specialties

Cited by 88 publications

References 23 publications

Imaging in the COVID-19 era: Lessons learned during a pandemic

Imaging in the COVID-19 era: Lessons learned during a pandemic

COVID-19 Vaccination Induced Lymphadenopathy in a Specialized Breast Imaging Clinic in Israel: Analysis of 163 cases

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

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