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Axillary Adenopathy Post Covid Vaccine

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This was a screening mammogram that was performed on a patient who had

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a COVID 19 vaccine one week previously. The vaccine was done in the

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right arm and on her MLO view, we noticed that there was what looked

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like an enlarged lymph node that's partially visualized up here in the right

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axilla. So the patient was given a BI RADS 0 and recommended to

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come back for a diagnostic ultrasound exam. These are the images from the

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ultrasound. So we do see this lymph node,

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which has some cortical thickening measuring up to four millimeters. Three

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millimeters is typically our cutoff for a lymph node.

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Because this was so soon after her COVID 19 vaccine, we followed the

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SBI recommendation and recommended for her to come back for

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a short term follow up to see if this resolved.

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When she came back, this was right at 12 weeks after her second

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vaccine. So we would expect the vaccine related adenopathy to resolve.

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We actually saw that the lymph node had gotten a little bit bigger.

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So now that, again, we see some of the cortical thickening

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measuring up to five or six millimeters and it looks like there's actually

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some eccentric cortical thickening here. This was then recommended for a

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biopsy and patient was diagnosed with CLL. This is unusual to have unilateral

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adenopathy with CLL, but it can happen. And this is a reason that

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we want to make sure we're following these patients to resolution of adenopathy,

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even when we think it's possibly related to the timing of a COVID

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vaccine. So this was a patient who was recalled from screening mammogram

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for axillary adenopathy. We did see some cortical thickening on her follow

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up. We thought because of the timing, so close to her COVID vaccine,

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it was likely reactive. Did not resolve at the 12 week follow up appointment

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and biopsy did show CLL. So this is just a good reminder and

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this is a new topic and may be evolving, but this is what

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the current guidelines are recommending that we do.

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Description

Faculty

Emily B. Ambinder, MD

Assistant Professor - Breast Imaging Division

The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine

Tags

Women's Health

Ultrasound

Non-infectious Inflammatory

Neoplastic

Mammography

Breast

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