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Abstract
Background and Objectives: Several authors have reported cervical and axillary lymphadenopathies as known side effects following anti-COVID-19 vaccine administration. Few data are available about atypical locations of post-anti-COVID-19 vaccine lymphadenopathy. In this investigation, we evaluated the incidence and prevalence of postvaccine lymphadenopathy ultrasound (US) features in atypical sites. Materials and Methods: In this retrospective study, we retrospectively selected 64 patients on whom US was performed between January and October 2021 due to COVID-19 vaccine-related lymphadenopathy. We investigated lymph node anatomical sites, presence, number, size, shape, cortical profile, hilum outline, superb microvascular imaging (SMI), and elastosonography. Results: A total of 170 nodes were assessed. Atypical location was demonstrated in 5/64 patients (7.8%). In all these cases, atypical nodal involvement was associated with lymphadenopathy in a typical site (axillary, supraclavicular) ipsilateral to the vaccine injection site. Two patients presented lymphadenopathy in the infraclavicular station (3.1%), one in the pectoralis major muscle (1.6%), one in the left arm (1.6%), and one in the nuchal site (1.6%). All lymphadenopathies were oval-shaped, with a median size of 0.9 ± 0.2 cm. US features included a symmetric cortex with hilum evidence (4/6, 60%), vascular signal at SMI in both the hilar region and periphery of lymph node (5/6, 83.3%), and a US elastography pattern resembling that of adjacent tissues (5/6, 83.3%). The median age of patients with lymphadenopathies in an atypical location was 23 years. The main type of vaccine associated with lymph node appearance in atypical sites was Moderna’s mRNA-1273 (60% of patients, 4/6 lymph nodes accounting for 66.7% among atypical locations). Conclusion: Post-COVID-19 vaccine administration lymphadenopathies in an atypical location represent an intense immune response to antigenic stimuli and they may show alarming US traits superimposed on malignant pathologies, which may complicate the patient’s clinical and diagnostic pathway. Despite no distinctive US features between reactive post-COVID-19 vaccination and malignant lymph nodes being available, careful examination of atypical lymph node locations associated with accurate knowledge of patients’ clinical background and delay of US exam to four to six weeks after vaccine injection should be considered.
Highlights
SARS-CoV-2, a virus of the family of Betacoronaviridae, is the etiological agent of COVID-19 disease, a severe illness with the first official case described in December 2019 in Wuhan, China, and currently verified as being responsible for about 4.8 million deaths [1,2]
Ultrasound (US) examination is a first-line imaging modality for evaluating morphologic lymph nodes due to its common accessibility and clear depiction of soft tissues and superficial structures provided by high-frequency linear probes [12,13]
Research into the peculiar characteristics associated with post-anti-COVID19 vaccine lymphadenopathy may allow the avoidance of worthless follow-up, expansive second-level diagnostic imaging, and invasive diagnostic procedures for selected patients
Summary
SARS-CoV-2, a virus of the family of Betacoronaviridae, is the etiological agent of COVID-19 disease, a severe illness with the first official case described in December 2019 in Wuhan, China, and currently verified as being responsible for about 4.8 million deaths [1,2]. The diagnostic overlap between the US features of lymph node involvement in benign and malignant disease is extremely relevant in the follow-up of neoplastic patients [17,18] In this setting, research into the peculiar characteristics associated with post-anti-COVID19 vaccine lymphadenopathy may allow the avoidance of worthless follow-up, expansive second-level diagnostic imaging, and invasive diagnostic procedures for selected patients. Despite no distinctive US features between reactive post-COVID-19 vaccination and malignant lymph nodes being available, careful examination of atypical lymph node locations associated with accurate knowledge of patients’ clinical background and delay of US exam to four to six weeks after vaccine injection should be considered
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