ABSTRACT
OBJECTIVE: This study aimed to determine the prevalence of axillary and subpectoral (SP) lymph nodes after ipsilateral COVID-19 vaccine administration on chest computed tomography (CT). METHODS: Subjects with chest CTs between 2 and 25 days after a first or second vaccine dose, December 15, 2020, to February 12, 2021, were included. Orthogonal measures of the largest axillary and SP nodes were recorded by 2 readers blinded to vaccine administration and clinical details. A mean nodal diameter discrepancy of ≥6 mm between contralateral stations was considered positive for asymmetry. Correlation with the side of vaccination, using a Spearman rank correlation, was performed on the full cohort and after excluding patients with diseases associated with adenopathy. RESULTS: Of the 138 subjects (81 women, 57 men; mean [SD] age, 74.4 ± 11.7 years), 48 (35%) had asymmetrically enlarged axillary and/or SP lymph nodes, 42 (30%) had ipsilateral, and 6 (4%) had contralateral to vaccination ( P = 0.003). Exclusion of 29 subjects with conditions associated with adenopathy showed almost identical correlation, with asymmetric nodes in 32 of 109 (29%) ipsilateral and in 5 of 109 (5%) contralateral to vaccination ( P = 0.002). CONCLUSIONS: Axillary and/or SP lymph nodes ipsilateral to vaccine administration represents a clinical conundrum. Asymmetric nodes were detected at CT in 30% of subjects overall and 29% of subjects without conditions associated with adenopathy, approximately double the prevalence rate reported to the Centers for Disease Control and Prevention by vaccine manufacturers. When interpreting examinations correlation with vaccine administration timing and site is important for pragmatic management.
Subject(s)
COVID-19 , Lymphadenopathy , Male , Humans , Female , Middle Aged , Aged , Aged, 80 and over , SARS-CoV-2 , COVID-19 Vaccines , Prevalence , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/pathology , Tomography, X-Ray Computed , Lymphadenopathy/diagnostic imaging , Lymphadenopathy/epidemiology , Lymphadenopathy/pathology , Lymph Nodes/diagnostic imaging , Lymph Nodes/pathology , VaccinationSubject(s)
Coronavirus Infections/epidemiology , Coronavirus , Internship and Residency , Pandemics , Pneumonia, Viral , Betacoronavirus , COVID-19 , Humans , SARS-CoV-2ABSTRACT
OBJECTIVE. The response to coronavirus disease (COVID-19) is evolving in New York City. We would like to share our experiences, thoughts, and perspectives on coping with the pandemic. CONCLUSION. This article presents experiences that are meant to help foster discussion as the wave of COVID-19 continues. Thoughtful leadership and careful continuous communication will help us minimize anxiety and frustration during this difficult time.