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mRNA COVID-19 aşısı ile ilişkili aksiller ve supraklaviküler lenfadenopatinin B-mod ve Doppler ultrasonografi paternleri

Year 2022, Volume: 47 Issue: 2, 891 - 897, 30.06.2022
https://doi.org/10.17826/cumj.1089995

Abstract

Bu çalışmada, Pfizer-BioNTech COVID-19 aşısının birinci veya ikinci dozundan sonra bölgesel lenf düğümü zincirinde ortaya çıkan lenf bezlerinin ultrason görüntüleme özelliklerini sunuyoruz. Aşı enjeksiyon bölgesine komşu ipsilateral lenfadenopati, COVID-19 aşısını takiben son derece nadir ancak beklenen bir advers reaksiyondur. Aksiller lenfadenopati daha yaygın olmasına rağmen, mevcut COVID-19'a karşı yaygın aşılama sonrasında supraklaviküler lenfadenopati vakaları da bildirilmiştir. Pfizer-BioNTech COVID-19 aşısı yapıldıktan sonra radyoloji bölümümüze başvuran, daha önce herhangi bir patolojik durumu olmayan yedi hastaya ultrasonografi incelemesi yapıldı. Bilateral aksiller, supraklaviküler ve subklaviküler lenf nodu istasyonları araştırıldı. Bu hastalar tipik olarak, ipsilateral aksiller ve supraklaviküler bölgelerde büyümüş hipoekoik lenf nodları ile birlikte yağ hilusu kaybı, asimetrik veya yaygın kortikal kalınlaşma ve renkli doppler ultrasonografisinde artmış hiler ve kortikal vaskülarizasyon ile başvururlar. Radyologlar ve klinisyenler bu lenf nodlarının ultrasonografik özelliklerinin farkında olmalı ve bu lenf nodlarının sıklıkla kendi kendini sınırlayan bir süreç olduğu konusunda hastayı iyi bilgilendirilmelidir. Bu nedenle gereksiz aksiller lenf nodu biyopsilerinden kaçınılmalı ve hastalar konservatif olarak tedavi edilmelidir.

References

  • 1-Becker AS, Perez-Johnston R, Chikarmane SA, et al. Multidisciplinary recommendations regarding post-vaccine adenopathy and radiologic imaging: radiology scientific expert panel. Radiology Feb 24 2021:210436. https://doi.org/ 10.1148/radiol.2021210436.
  • 2-Edmonds CE, Zuckerman SP, Conant EF. Management of unilateral axillary lymphadenopathy detected on breast MRI in the era of coronavirus disease (COVID-19) vaccination. AJR Am J Roentgenol 2021. https://doi.org/10.2214/AJR.21.25604.
  • 3-Mehta N, Sales RM, Babagbemi K, et al. Unilateral axillary adenopathy in the setting of COVID-19 vaccine. Clin Imaging 2021;75:12–15.
  • 4-Lehman CD, D’Alessandro HA, Mendoza DP, Succi MD, Kambadakone A, Lamb LR. Unilateral lymphadenopathy after COVID-19 vaccination: a practical management plan for radiologists across specialties. J Am Coll Radiol June 01, 2021;18:843–852.
  • 5-Kim B, Park Y, Kim EK, Lee SH. Supraclavicular lymphadenopathy after COVID-19 vaccination in Korea: serial follow-up using ultrasonography. Clin Imaging 2021;79:201-203. doi: 10.1016/j.clinimag.2021.05.031.
  • 6-'Auria D, Fulgione L, Romeo V, Stanzione A, Maurea S, Brunetti A. Ultrasound and shear-wave elastography patterns of COVID-19 mRNA vaccine-related axillary, supra and subclavicular lymphadenopathy. Clin Transl Imaging 2021;18:1-7. doi: 10.1007/s40336-021-00441-0.
  • 7-Dagan N, Barda N, Kepten E, et al. BNT162b2 mRNA Covid-19 vaccine in a nationwide mass vaccination setting. N Engl J Med. (2021). https:// doi. org/ 10. 1056/ NEJMo a2101 765 (PMID: 33626250; PMCID: PMC7944975)
  • 8-Özütemiz C, Krystosek LA, Church AL, et al. Lymphadenopathy in COVID-19 vaccine recipients: diagnostic dilemma in oncology patients. Radiology 2021;24:210275. https:// doi. org/ 10. 1148/ radiol. 20212 10275
  • 9-Ahn RW, Mootz AR, Brewington CC, Abbara S. Axillary lymphadenopathy after mRNA COVID-19 vaccination. Radiol Cardiothorac Imaging 2021; 3(1):e210008. https:// doi. org/ 10. 1148/ ryct. 20212 10008
  • 10-Fernández-Prada M, Rivero-Calle I, Calvache-González A, Martinón-Torres F. Acute onset supraclavicular lymphadenopathy coinciding with intramuscular mRNA vaccination against COVID-19 may be related to vaccine injection technique, Spain, January and February 2021. Euro Surveill 2021;26:2100193. doi: 10.2807/1560-7917.ES.2021.26.10.2100193.
  • 11-Polack FP, Thomas SJ, Kitchin N, et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med 2020;383:2603–2615.
  • 12-Centers for Disease Control and Prevention (2021) Local reactions, systemic reactions, adverse events, and serious adverse events: Pfizer-BioNTech COVID-19 vaccine. https:// www. cdc. gov/ vacci nes/ covid- 19/ info- by- produ ct/ pfizer/ react ogeni city. html. Accessed 16 Jan 2021
  • 13-Washington T, Bryan R, Clemow C. Adenopathy Following COVID-19 Vaccination. Radiology. 2021;299:E280-E281. doi: 10.1148/radiol.2021210236.
  • 14-Mitchell OR, Dave R, Bekker J, Brennan PA. Supraclavicular lymphadenopathy following COVID-19 vaccination: an increasing presentation to the two-week waitneck lump clinic? Br J Oral Maxillofac Surg 2021;59:384–385.
  • 15-Hiller N, Goldberg SN, Cohen-Cymberknoh M, Vainstein V, Simanovsky N. Lymphadenopathy associated with the COVID-19 vaccine. Cureus 2021;13:e13524.

B-mode and Doppler ultrasonography patterns of axillary and supraclavicular lymphadenopathy associated with mRNA COVID-19 vaccine

Year 2022, Volume: 47 Issue: 2, 891 - 897, 30.06.2022
https://doi.org/10.17826/cumj.1089995

Abstract

In this study, we present the ultrasound imaging features of lymph nodes arising in the regional lymph node chain after the first or second dose of the Pfizer-BioNTech COVID-19 vaccine. Ipsilateral lymphadenopathy adjacent to the vaccine injection site is an extremely rare but expected adverse reaction following COVID-19 vaccination. Although axillary lymphadenopathy is more common, cases of supraclavicular lymphadenopathy have also been reported after widespread vaccination against COVID-19. Ultrasonography examinations were performed on seven patients with no previous pathological conditions, who presented to our radiology department after receiving the Pfizer-BioNTech COVID-19 vaccine. Bilateral axillary, supraclavicular and subclavicular lymph node stations were explored. These patients typically present with enlarged hypoechoic lymph nodes with the loss of fatty hilum, asymmetric or diffuse cortical thickening, and increased hilar and cortical vascularization on the color doppler ultrasonography of the ipsilateral axillary and supraclavicular regions. Radiologists and clinicians should be aware of the ultrasonographic features of these lymph nodes and should inform the patient that these lymph nodes are often a self-limiting process. Thus, unnecessary axillary lymph node biopsies should be avoided, and patients should be treated conservatively.

References

  • 1-Becker AS, Perez-Johnston R, Chikarmane SA, et al. Multidisciplinary recommendations regarding post-vaccine adenopathy and radiologic imaging: radiology scientific expert panel. Radiology Feb 24 2021:210436. https://doi.org/ 10.1148/radiol.2021210436.
  • 2-Edmonds CE, Zuckerman SP, Conant EF. Management of unilateral axillary lymphadenopathy detected on breast MRI in the era of coronavirus disease (COVID-19) vaccination. AJR Am J Roentgenol 2021. https://doi.org/10.2214/AJR.21.25604.
  • 3-Mehta N, Sales RM, Babagbemi K, et al. Unilateral axillary adenopathy in the setting of COVID-19 vaccine. Clin Imaging 2021;75:12–15.
  • 4-Lehman CD, D’Alessandro HA, Mendoza DP, Succi MD, Kambadakone A, Lamb LR. Unilateral lymphadenopathy after COVID-19 vaccination: a practical management plan for radiologists across specialties. J Am Coll Radiol June 01, 2021;18:843–852.
  • 5-Kim B, Park Y, Kim EK, Lee SH. Supraclavicular lymphadenopathy after COVID-19 vaccination in Korea: serial follow-up using ultrasonography. Clin Imaging 2021;79:201-203. doi: 10.1016/j.clinimag.2021.05.031.
  • 6-'Auria D, Fulgione L, Romeo V, Stanzione A, Maurea S, Brunetti A. Ultrasound and shear-wave elastography patterns of COVID-19 mRNA vaccine-related axillary, supra and subclavicular lymphadenopathy. Clin Transl Imaging 2021;18:1-7. doi: 10.1007/s40336-021-00441-0.
  • 7-Dagan N, Barda N, Kepten E, et al. BNT162b2 mRNA Covid-19 vaccine in a nationwide mass vaccination setting. N Engl J Med. (2021). https:// doi. org/ 10. 1056/ NEJMo a2101 765 (PMID: 33626250; PMCID: PMC7944975)
  • 8-Özütemiz C, Krystosek LA, Church AL, et al. Lymphadenopathy in COVID-19 vaccine recipients: diagnostic dilemma in oncology patients. Radiology 2021;24:210275. https:// doi. org/ 10. 1148/ radiol. 20212 10275
  • 9-Ahn RW, Mootz AR, Brewington CC, Abbara S. Axillary lymphadenopathy after mRNA COVID-19 vaccination. Radiol Cardiothorac Imaging 2021; 3(1):e210008. https:// doi. org/ 10. 1148/ ryct. 20212 10008
  • 10-Fernández-Prada M, Rivero-Calle I, Calvache-González A, Martinón-Torres F. Acute onset supraclavicular lymphadenopathy coinciding with intramuscular mRNA vaccination against COVID-19 may be related to vaccine injection technique, Spain, January and February 2021. Euro Surveill 2021;26:2100193. doi: 10.2807/1560-7917.ES.2021.26.10.2100193.
  • 11-Polack FP, Thomas SJ, Kitchin N, et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med 2020;383:2603–2615.
  • 12-Centers for Disease Control and Prevention (2021) Local reactions, systemic reactions, adverse events, and serious adverse events: Pfizer-BioNTech COVID-19 vaccine. https:// www. cdc. gov/ vacci nes/ covid- 19/ info- by- produ ct/ pfizer/ react ogeni city. html. Accessed 16 Jan 2021
  • 13-Washington T, Bryan R, Clemow C. Adenopathy Following COVID-19 Vaccination. Radiology. 2021;299:E280-E281. doi: 10.1148/radiol.2021210236.
  • 14-Mitchell OR, Dave R, Bekker J, Brennan PA. Supraclavicular lymphadenopathy following COVID-19 vaccination: an increasing presentation to the two-week waitneck lump clinic? Br J Oral Maxillofac Surg 2021;59:384–385.
  • 15-Hiller N, Goldberg SN, Cohen-Cymberknoh M, Vainstein V, Simanovsky N. Lymphadenopathy associated with the COVID-19 vaccine. Cureus 2021;13:e13524.
There are 15 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Case Report
Authors

Veysel Kaplanoğlu 0000-0002-1376-0469

Hatice Kaplanoğlu 0000-0003-1874-8167

Aynur Turan 0000-0001-6654-3129

Alper Dilli 0000-0002-8057-9109

Publication Date June 30, 2022
Acceptance Date April 26, 2022
Published in Issue Year 2022 Volume: 47 Issue: 2

Cite

MLA Kaplanoğlu, Veysel et al. “B-Mode and Doppler Ultrasonography Patterns of Axillary and Supraclavicular Lymphadenopathy Associated With MRNA COVID-19 Vaccine”. Cukurova Medical Journal, vol. 47, no. 2, 2022, pp. 891-7, doi:10.17826/cumj.1089995.