Type:
Educational Exhibit
Keywords:
Breast, Lymph nodes, CT, MR, Ultrasound, Biopsy, Cancer
Authors:
A. H. Brown, S. Shah, S. L. Dluzewski, B. Musaddaq, A. Malhotra
DOI:
10.26044/ecr2022/C-13240
Conclusion
Unilateral axillary adenopathy is a commonly encountered side effect of COVID-19 vaccination and will be further encountered by radiologists during future COVID-19 booster vaccination programmes.
Imaging findings of reactive adenopathy are non-specific, usually consisting of lymph node enlargement and symmetrical cortical thickening. Therefore important consideration must be given to the patient's vaccine history and relevant cancer risk factors to determine appropriate follow up and management. Particular caution must be taken in patients with a history of breast cancer; there should be a low threshold for follow-up imaging and biopsy in such instances.
At our institution, we implemented a pre-imaging questionnaire which was completed by patients prior to any imaging of the axilla. This included information such as when the patient received the vaccine, in which arm and which type of vaccine. This aided our interpretation of any axillary adenopathy detected on the subsequent scan and thereby reduced the volume of unncessary follow up imaging.
We believe patients with a recent vaccination history and isolated ipsilateral axillary adenopathy should not be subject to biopsy or follow up unless there is clinical doubt or a history of malignancy. It should be noted that a recent study demonstrated that axillary lymphadenopathy can be seen for as long as 43 weeks after vaccination.1