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. 2021;9(5):539-545.
doi: 10.1007/s40336-021-00441-0. Epub 2021 Jun 18.

Ultrasound and shear-wave elastography patterns of COVID-19 mRNA vaccine-related axillary, supra and subclavicular lymphadenopathy

Divina D'Auria #  1 , Ludovica Fulgione #  1 , Valeria Romeo  1 , Arnaldo Stanzione  1 , Simone Maurea  1 , Arturo Brunetti  1
Affiliations

Ultrasound and shear-wave elastography patterns of COVID-19 mRNA vaccine-related axillary, supra and subclavicular lymphadenopathy

Divina D'Auria et al. Clin Transl Imaging. 2021.

Abstract

In this pictorial essay, we illustrate the ultrasound appearance of COVID-19 Pfizer-BioNTech vaccine-related lymph node abnormalities, which can occur at different stations ipsilateral to the site of vaccination, after either first or second vaccine dose and can represent a diagnostic dilemma when encountered in patients with underlying conditions. Typically, they appear as enlarged hypoechoic nodes with loss of fat hilum, increased hilar and cortical vascularization at color-Doppler, but low to intermediate cortical consistence at shear-wave elastography. Asymmetric or diffuse cortical thickening is also frequently encountered. They can be observed in patients without and with clinical symptoms, such as armpit pain, fever and fatigue.

Keywords: Covid-19; Lymphadenopathy; Shear-wave elastography; Ultrasound; Vaccine; mRNA vaccine.

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Conflict of interest statement

Conflict of interestAll the authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
B-Mode (A) and color-Doppler (B) US examination performed in a 28-year-old woman 2 days after receiving the second dose of vaccine: axillary lymph nodes (maximum diameter 14 × 9 mm) with fatty hilum but diffuse cortical thickening (maximum 10 mm, arrows in A) and vivid hilar and cortical vascularization (B) were detected. B-Mode (C) and color-Doppler (D) US examination performed after 4 weeks: reduction of lymph nodes size (7 × 6 mm), cortical thickness (2.9 mm) and vascularization was observed
Fig. 2
Fig. 2
B-Mode (A, B) and color-Doppler (B, D) US examination performed in a 28-year-old woman 2 days after receiving the second dose of vaccine. Enlarged (33 × 11 mm) subclavicular lymph node with no detectable fatty hilum (A) and vivid hilar and cortical vascularization (B) was detected. Enlarged axillary lymph node (26 × 7 mm) with cortical thickening (5 mm) (C) and increased vascularization (D) were also found
Fig. 3
Fig. 3
B-Mode (A) and color-Doppler (B) US examination performed 3 days after receiving the second vaccine dose. Multiple round (maximum diameter 11 × 10 mm) axillary lymph nodes with no fatty hilum and mild hilar vascularization were detected. B-Mode (C, D) and color-Doppler (E) US examination performed after 5 weeks. Only a reduction of lymph node size (maximum diameter 9 × 6 mm) was detectable.
Fig. 4
Fig. 4
B-Mode (A, C) and color-Doppler (B, D) US examination performed 3 days after receiving the second dose of vaccine. Enlarged (maximum diameter 21 × 7 mm) axillary lymph node with preserved fatty hilum (* in A and C), diffuse cortical thickening (6 mm, arrows in A and C) and vivid hilar and cortical vascularization (B, D) were found
Fig. 5
Fig. 5
B-Mode (A), color-Doppler (B) and shear wave (C) US examination performed 8 days after receiving the first dose of vaccine. Enlarged (14 × 6 mm) supraclavicular lymph node with no fatty hilum (A), increased hilar and cortical vascularization (B) and soft-intermediate consistence at shear-wave elastography (C) is shown
Fig. 6
Fig. 6
B-Mode (A) and color-Doppler (B) US examination performed 2 days after receiving the first dose of vaccine: multiple axillary lymph nodes (maximum diameter 15 × 10 mm) with poorly represented fatty hilum (A) and moderate vascularization (B) were found. B-Mode (C) and color-Doppler (D) US examination performed after 4 weeks. Although lymph node size remained stable, fatty hilum was restored (C) and vascularization reduced at color-Doppler (D)
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