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. 2021 Jul:75:12-15.
doi: 10.1016/j.clinimag.2021.01.016. Epub 2021 Jan 19.

Unilateral axillary Adenopathy in the setting of COVID-19 vaccine

Nishi Mehta  1 , Rachel Marcus Sales  2 , Kemi Babagbemi  3 , Allison D Levy  4 , Anika L McGrath  5 , Michele Drotman  6 , Katerina Dodelzon  7
Affiliations

Unilateral axillary Adenopathy in the setting of COVID-19 vaccine

Nishi Mehta et al. Clin Imaging. 2021 Jul.

Abstract

With the recent U.S. Food and Drug Administration (FDA)-approval and rollout of the Pfizer-BioNTech and Moderna COVID-19 vaccines, it is important for radiologists to consider recent COVID-19 vaccination history as a possible differential diagnosis for patients with unilateral axillary adenopathy. Hyperplastic axillary nodes can be seen on sonography after any vaccination but are more common after a vaccine that evokes a strong immune response, such as the COVID-19 vaccine. As the differential of unilateral axillary adenopathy includes breast malignancy, it is crucial to both thoroughly evaluate the breast for primary malignancy and to elicit history of recent vaccination. As COVID-19 vaccines will soon be available to a larger patient population, radiologists should be familiar with the imaging features of COVID-19 vaccine induced hyperplastic adenopathy and its inclusion in a differential for unilateral axillary adenopathy. Short-term follow-up for unilateral axillary adenopathy in the setting of recent COVID-19 vaccination is an appropriate recommendation, in lieu of immediately performing potentially unnecessary and costly axillary lymph node biopsies.

Keywords: Breast imaging; COVID-19; Screening; Unilateral axillary adenopathy; Vaccine.

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Figures

Fig. 1
Fig. 1
59-year-old female with palpable unilateral left axillary adenopathy noted approximately 9 days after receiving the first dose of the Pfizer-BioNTech Covid-19 vaccine in her left upper extremity. (a) Gray-scale and (b) color Doppler images of an enlarged left axillary lymph node measuring 2.6 × 1.5 × 1.6 cm with uniform cortical thickening up to 0.7 cm (arrow). Normal right axillary lymph node (arrowhead) was noted.
Fig. 2
Fig. 2
42-year-old female with unilateral left axillary adenopathy noted 5 days after receiving the second dose of the Pfizer-BioNTech COVID-19 vaccine in her left upper extremity. (a) Gray-scale and (b) color Doppler images of an enlarged left axillary lymph node with cortical thickening (arrow). (c) Multiple additional morphologically abnormal left axillary lymph nodes were also present (arrows). Unremarkable right axilla was documented (d).
Fig. 3
Fig. 3
42-year-old female with unilateral left axillary adenopathy noted 13 days after receiving the first dose of the Moderna COVID-19 vaccine in her left upper extremity. (a) Gray-scale and (b) color Doppler images of an enlarged left axillary lymph node with diffuse cortical thickening (arrows). Unremarkable right axilla was documented (c).
Fig. 4
Fig. 4
57-year-old female with unilateral left axillary adenopathy noted 8 days after receiving the first dose of the Pfizer-BioNTech Covid-19 vaccine in her left upper extremity. (a) Gray-scale and (b) color Doppler images of a single enlarged left axillary lymph node with diffuse cortical thickening. Unremarkable right axilla was documented (c).
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