Learning objectives
The purpose of this exhibit is to demonstrate benign and malignant mimickers of reactive axillary lymph nodes in patients who recently underwent COVID vaccination. This is important to understand, as management varies greatly (imaging follow up, biopsy, or further imaging).
Background
The recent increase in COVID vaccinations has caused a diagnostic dilemma for women undergoing screening mammography. Currently, guidelines from the Society of Breast Imaging advocate sonographic follow up in 4-12 months for abnormal lymph nodes that are thought to be reactive. However, it is crucial to recognize other oval or round structures in the axilla that may mimic the appearance of reactive axillary lymph nodes in patients who have had undergone COVID vaccination, as management can greatly vary. These entities include breast malignancy, non breast...
Findings and procedure details
An abnormal lymph node is characterized by a thickened or eccentrically thickened cortex with an effaced or absent fatty hilum, and can represent a reactive process such as vaccination or sequelae from malignancy.
The most common malignancy to metastasize to the axillary lymph node is primary breast malignancy and is often high in the early differential.
Non breast malignancies, such as soft tissue sarcomas, are important to distinguish due to their aggressive nature and necessary treatment regimen. Sarcomas represent a diverse group of malignancies that...
Conclusion
In the age of increasing COVID vaccinations, it is key to differentiate reactive axillary lymphadenopathy from breast malignancy, non breast malignancy, and benignities that share similar imaging appearances. This has significant implications for management, which range from return to screening to biopsy.
Personal information and conflict of interest
T. L. Chan:
Nothing to disclose
C. FISCHER:
Nothing to disclose
References
Grimm, L., Destounis, S., Dogan, B., Nicholson, B., Dontchos, B., Sonnenblick, E., ... & Perera, V. (2021). SBI recommendations for the management of axillary adenopathy in patients with recent COVID-19 vaccination.Virginia: Society of Breast Imaging Patient Care and Delivery Committee,9.
Net, J. M., Mirpuri, T. M., Plaza, M. J., Escobar, C. A., Whittington, E. E., Collado-Mesa, F., & Yepes, M. M. (2014). Resident and fellow education feature: US evaluation of axillary lymph nodes.Radiographics,34(7), 1817-1818.