0:00

So this was an interesting couple of cases.

0:03

that I interpreted on a Monday morning.

0:07

So I show up and on my list and

0:08

I saw two brachial plexus MRIs.

0:11

And, um, it was great because

0:13

I love reading the brachial plexus.

0:14

So I looked at it and this patient was an

0:18

18-year-old female that presented with a left

0:24

brachial plexopathy, specifically a neuritis.

0:28

So I started looking at this case.

0:30

And what kind of struck me was this

0:32

patient had a bunch of lymph nodes.

0:33

In fact, they were asymmetrically

0:35

enlarged lymph nodes on the left

0:37

side compared to the right side.

0:39

And when you look even closer, you

0:41

can see some of these lymph nodes are

0:43

directly abutting the brachial plexus

0:45

on the non-contrast T1-weighted image.

0:48

So then we did one of our advanced sequences,

0:51

which is an STIR sequence, which is really

0:53

optimized to look at the nerve itself.

0:56

And when you look at this, you beautifully

0:57

see these enlarged lymph nodes

1:00

involving the left axillary region,

1:03

and we can see that this is actually

1:04

abutting the brachial plexus.

1:06

And when we even look more proximally,

1:08

we can see more lymph nodes abutting

1:10

the junction between the supra and

1:12

infraclavicular portion of the brachial plexus.

1:15

So I was a little bit perplexed by this study,

1:18

so I ended up calling the orthopedic surgeon

1:21

up, and he called me back, and I said, "Hey,

1:23

you know, what's going on with this patient?

1:25

Because I started worrying about things such

1:27

as lymphoma, and so on and so forth," and he

1:30

said, "No, they never had a history of lymphoma,

1:32

no systemic diseases, and they're a violinist,

1:36

and this is a violinist, and he's concerned

1:38

that it's due to overplaying or overuse of the

1:42

elbow because they were practicing too much."

1:44

very much.

1:45

And then he said, "Well, what about the sister?

1:48

Does the sister have it?"

1:49

And I said, "The sister?"

1:50

And lo and behold, I open up

1:52

the next brachial plexus, and lo and

1:54

behold, it's the sister as well, too.

1:57

So now in the sister, again, lots

1:59

of enlarged lymph nodes in the

2:00

non-contrast T1-weighted image.

2:02

When we look at this collapsed

2:04

image, again, we see multiple lymph

2:06

nodes involving the left axilla.

2:09

And I remember I specifically asked the patient,

2:11

I said, "Is it possible they had a COVID vaccine?"

2:14

And the surgeon said, "There's no

2:15

history that they had the COVID vaccine."

2:18

So anyway, I went ahead and dictated out.

2:21

And again, I was a little

2:21

bit concerned about this,

2:23

potentially being associated

2:25

with the COVID vaccine.

2:27

And then it turns out when our team called up

2:30

the parents, both of these kids had had their

2:33

recent COVID vaccine about three weeks ago.

2:36

And this was likely due to an

2:38

association with the COVID vaccine.

2:40

We can see the enlarged lymph nodes

2:41

and a little bit of increased signal

2:42

involving the cords of the brachial plexus.

2:46

Now, I don't want to say that this is

2:48

a complication of the COVID vaccine.

2:49

This was just an association.

2:51

Personally, I've had two doses,

2:53

and then I've had three boosters.

2:54

So, I've actually had five of the vaccinations.

2:57

So, the COVID vaccine is safe.

2:59

You should always get it.

3:01

But occasionally, as we all know, you

3:03

can have COVID-associated lymphadenopathy

3:05

involved in the axillary region.

3:07

So this is just one of the

3:09

effects of the COVID vaccine.

3:11

And in this particular case, this was

3:12

associated with ipsilateral enlarged lymph nodes

3:15

resulting in slight brachial plexus neuritis.