Detection of axillary lymphadenopathy after Covid-19 vaccination during breast examination: Case series and review of the literature after one year.

OBJECTIVES: The aim of this study is to evaluate accidental findings of axillary lymphadenopathy during breast examination. Postvaccination axillary lymphadenopathy is a possible cause of adenopathies but these findings used to be exceedingly rare. Nowadays, after Covid-19 vaccination it is found more often. Covid-19 vaccination started at the end of December 2020 with two types of vaccine, Moderna and Pfizer-BioNTech in the Czech Republic. The aim of this article is to present a single centre experience with Covid-19 lymphadenopathy during the general vaccination in the Czech population and summarization of recommendations. METHODS: In January to February 2021 ultrasound revealed axillary lymphadenopathy in several patients during breast examination in our certified centre. In four of them it was concluded as lymphadenopathy after Covid-19 vaccination. A search (using databases PubMed and Google Scholar) of the available literature for the years 2020 and 2021 was performed. RESULTS: These four patients were examined during the first two months of 2021. In all of them pathological lymph nodes with typical sonographic signs were seen in the ipsilateral axilla. We searched the literature for follow-up recommendations and summarized them in our article. CONCLUSION: Accidental findings of axillary lymphadenopathy during ultrasound breast examination will be more often. There will be more cases of lymphadenopathy with an increasing number of people being vaccinated against Covid-19.

Color Doppler Ultrasound in the pre-histological determination of the biological character of major salivary gland tumors.

OBJECTIVES: The aim of the study was to assess the use of color Doppler ultrasound in the pre-histological determination of the biological features of salivary gland tumors. MATERIAL AND METHODS: Ninety-six patients with major salivary gland tumors of unknown histology were examined and operated on in our clinics. They were pre-operatively examined using ultrasound imaging with color Doppler. Peak systolic velocity (PSV) was measured and pulsatility index (PI) and resistive index (RI) were calculated on the pulsed wave traces. The Doppler flow parameters were correlated with clinical stage and tumour type (benign/carcinoma) as confirmed by final histological diagnosis. For the correlations, the tumors were categorized into 3: benign (group I), malignant stages I+II (group II), malignant stages III+IV (group III). RESULTS: The average PSV value was 22.15 cm/s for benign and 32.74 cm/s for all malignant tumors. The average RI value was 0.77 for benign and 0.86 for all malignant tumors. The average PI value for benign tumors was 2.85 and 3.14 for all malignant tumors. No significant differences between benign and malignant tumors in terms of SV and PI values were found. The RI values for benign tumors differed significantly from those of malignant ones (P=0.021). There were no significant differences in average PSV, PI and RI values in relation to salivary gland tumor group - I, II, III. There was no confirmation of the reported applicability of PSV and PI values in differenting benign from malignant tumors. CONCLUSION: We were not able to demonstrate significant differences in Doppler flow parameters PSV and PI between benign tumors and carcinomas. Only the RI could be used to differentiate them. There were also no significant differences in PSV, PI and RI values between low (I+II) and high (III+IV) clinical tumour stage.

Subintimal angioplasty in femoropopliteal region-Mid-term results.

PURPOSE: Subintimal angioplasty is becoming more frequently used treatment option for patients with long arterial occlusions or diffuse atherosclerotic changes as an alternative to surgical treatment in claudicants especially in patients with critical limb ischemia. The aim of our article is to retrospectively assess mid-term outcomes of subintimal angioplasty of chronic arterial occlusions in femoropopliteal region followed clinically and by Doppler ultrasonography. MATERIALS AND METHODS: From May 2002 to December 2007, 133 femoropopliteal artery occlusions in 123 patients were indicated for subintimal recanalisation. The indications for treatment were intermittent claudications in 84 patients (63.15%) and critical limb ischemia in 49 patients (36.85%). The median length of lesions was 11.4 cm, range 2-30 cm. Except doppler ultrasonographic examination done 24h after the procedure and clinical examination before discharge, both clinical and ultrasonographic examinations were performed 6 and 12 months after the procedure and yearly thereafter. Statistical analysis of our cohort was performed by Kaplan-Meier analysis, log-rank test and Cox regression. RESULTS: Technical success was achieved in 86.46%. Primary patency rate was 83.1% (SE: 3.9%), 67.5% (SE: 5%), 58% (SE: 5.9%) a 48.4% (SE: 7.1%) at 6, 12, 24 and 36 months respectively. No statistically significant difference of primary patency was found between the group of claudicants and the group of patient with critical limb ischemia. Statistically significant prediction factors for primary patency were only the quality of the run off and the length of the occlusion. Limb salvage rate in our group of patients with critical limb ischemia was 80.8% at 12 months. CONCLUSION: : Subintimal recanalisation is a simple and safe procedure for treatment of chronic peripheral arterial occlusions with high primary technical success rate, acceptable primary patency rate, low percentage of complications and mortality is as low as nil. Subintimal angioplasty is definitely advantageous and fast method in patients with critical limb ischemia with high possibility of limb salvage. Surgical treatment can be replaced by subintimal angioplasty in claudicants with high risk of operative treatment, without suitable autologous vein graft or where distal femoropopliteal or femorocrural bypass is needed.

The value of dynamic contrast enhanced breast MRI in mammographically detected BI-RADS 5 microcalcifications.

AIMS: To evaluate the role of dynamic contrast-enhanced magnetic resonance imaging (MRI) in the diagnosis of BI-RADS-5 type of microcalcifications of the breast, to compare the size of the microcalcification lesions using mammography (MG) and MRI, and to determine the value of MRI in surgery for microcalcifications. The study also determines the morphology of microcalcification lesions, assesses kinetic curves and compare MRI features of ductal carcinoma in situ (DCIS) for different histopathological grades. METHODS: Our group consisted of 32 patients with mammographically detected BI-RADS 5 microcalcifications. The MRI was done in this group of women which was later followed by stereotactic vaccum-assisted biopsy (SVAB). Surgery was performed on all patients with a biopsy that resulted in a diagnosis of breast cancer or atypical ductal hyperplasia (ADH). RESULTS: Of our group of 32 patients, there were 35 mammograhically detected microcalcification lesions, 32 DCIS, one ADH and two benign findings according to the final histology. The microcalcification lesions were larger using MRI than in MG in 10 women. We diagnosed DCIS multifocality in 6 women and bilateral carcinoma in one woman. As with kinetic curve assessment, we found in 67 % of DCIS a rapid rise, 27 % a moderate and in 6 % a slow initial rise. With the pattern of enhancement in the delayed phase, we found in 30 % of DCIS a washout pattern, 67 % a plateau and in 3 % a persistent pattern. Noted difference between high and low grade DCIS was confirmed. CONCLUSIONS: MRI sensitivity in the detection of DCIS was 94 % in our group of patients and was the sole evidence for detection of multifocality and bilateral incidence of carcinoma. In 26 % of women the outcome of MRI was the most important for converting breast conserving surgery to mastectomy.