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Atypical Sites of Lymphadenopathy after Anti-COVID-19 Vaccine: Ultrasound Features.
Cocco, Giulio; Delli Pizzi, Andrea; Taraschi, Alessio Lino; Boccatonda, Andrea; Corvino, Antonio; Ucciferri, Claudio; Falasca, Katia; Caulo, Massimo; Vecchiet, Jacopo.
  • Cocco G; Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. d'Annunzio" University, 66100 Chieti, Italy.
  • Delli Pizzi A; Department of Innovative Technologies in Medicine and Dentistry, "G. d'Annunzio" University, 66100 Chieti, Italy.
  • Taraschi AL; Department of Innovative Technologies in Medicine and Dentistry, "G. d'Annunzio" University, 66100 Chieti, Italy.
  • Boccatonda A; Department of Internal Medicine, Bentivoglio Hospital, AUSL Bologna, 40010 Bentivoglio, Italy.
  • Corvino A; Motor Science and Wellness Department, University of Naples "Parthenope", 80133 Naples, Italy.
  • Ucciferri C; Clinic of Infectious Diseases, Department of Medicine and Science of Aging, "G. d'Annunzio" University, 66100 Chieti, Italy.
  • Falasca K; Clinic of Infectious Diseases, Department of Medicine and Science of Aging, "G. d'Annunzio" University, 66100 Chieti, Italy.
  • Caulo M; Department of Innovative Technologies in Medicine and Dentistry, "G. d'Annunzio" University, 66100 Chieti, Italy.
  • Vecchiet J; Clinic of Infectious Diseases, Department of Medicine and Science of Aging, "G. d'Annunzio" University, 66100 Chieti, Italy.
Medicina (Kaunas) ; 58(2)2022 Jan 27.
Article in English | MEDLINE | ID: covidwho-1686885
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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Lymphadenopathy / COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study Topics: Long Covid / Vaccines Limits: Adult / Humans / Young adult Language: English Journal subject: Medicine Year: 2022 Document Type: Article Affiliation country: Medicina58020197

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Lymphadenopathy / COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study Topics: Long Covid / Vaccines Limits: Adult / Humans / Young adult Language: English Journal subject: Medicine Year: 2022 Document Type: Article Affiliation country: Medicina58020197