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Atypical Sites of Lymphadenopathy after Anti-COVID-19 Vaccine: Ultrasound Features

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 th...

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Autores principales: Cocco, Giulio, Delli Pizzi, Andrea, Taraschi, Alessio Lino, Boccatonda, Andrea, Corvino, Antonio, Ucciferri, Claudio, Falasca, Katia, Caulo, Massimo, Vecchiet, Jacopo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8878753/
https://www.ncbi.nlm.nih.gov/pubmed/35208521
http://dx.doi.org/10.3390/medicina58020197
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author Cocco, Giulio
Delli Pizzi, Andrea
Taraschi, Alessio Lino
Boccatonda, Andrea
Corvino, Antonio
Ucciferri, Claudio
Falasca, Katia
Caulo, Massimo
Vecchiet, Jacopo
author_facet Cocco, Giulio
Delli Pizzi, Andrea
Taraschi, Alessio Lino
Boccatonda, Andrea
Corvino, Antonio
Ucciferri, Claudio
Falasca, Katia
Caulo, Massimo
Vecchiet, Jacopo
author_sort Cocco, Giulio
collection PubMed
description 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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spelling pubmed-88787532022-02-26 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 Medicina (Kaunas) Article 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. MDPI 2022-01-27 /pmc/articles/PMC8878753/ /pubmed/35208521 http://dx.doi.org/10.3390/medicina58020197 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Cocco, Giulio
Delli Pizzi, Andrea
Taraschi, Alessio Lino
Boccatonda, Andrea
Corvino, Antonio
Ucciferri, Claudio
Falasca, Katia
Caulo, Massimo
Vecchiet, Jacopo
Atypical Sites of Lymphadenopathy after Anti-COVID-19 Vaccine: Ultrasound Features
title Atypical Sites of Lymphadenopathy after Anti-COVID-19 Vaccine: Ultrasound Features
title_full Atypical Sites of Lymphadenopathy after Anti-COVID-19 Vaccine: Ultrasound Features
title_fullStr Atypical Sites of Lymphadenopathy after Anti-COVID-19 Vaccine: Ultrasound Features
title_full_unstemmed Atypical Sites of Lymphadenopathy after Anti-COVID-19 Vaccine: Ultrasound Features
title_short Atypical Sites of Lymphadenopathy after Anti-COVID-19 Vaccine: Ultrasound Features
title_sort atypical sites of lymphadenopathy after anti-covid-19 vaccine: ultrasound features
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8878753/
https://www.ncbi.nlm.nih.gov/pubmed/35208521
http://dx.doi.org/10.3390/medicina58020197
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