Interactive Transcript
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So this was an interesting couple of cases.
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that I interpreted on a Monday morning.
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So I show up and on my list and
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I saw two brachial plexus MRIs.
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And, um, it was great because
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I love reading the brachial plexus.
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So I looked at it and this patient was an
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18-year-old female that presented with a left
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brachial plexopathy, specifically a neuritis.
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So I started looking at this case.
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And what kind of struck me was this
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patient had a bunch of lymph nodes.
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In fact, they were asymmetrically
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enlarged lymph nodes on the left
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side compared to the right side.
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And when you look even closer, you
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can see some of these lymph nodes are
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directly abutting the brachial plexus
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on the non-contrast T1-weighted image.
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So then we did one of our advanced sequences,
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which is an STIR sequence, which is really
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optimized to look at the nerve itself.
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And when you look at this, you beautifully
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see these enlarged lymph nodes
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involving the left axillary region,
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and we can see that this is actually
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abutting the brachial plexus.
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And when we even look more proximally,
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we can see more lymph nodes abutting
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the junction between the supra and
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infraclavicular portion of the brachial plexus.
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So I was a little bit perplexed by this study,
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so I ended up calling the orthopedic surgeon
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up, and he called me back, and I said, "Hey,
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you know, what's going on with this patient?
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Because I started worrying about things such
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as lymphoma, and so on and so forth," and he
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said, "No, they never had a history of lymphoma,
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no systemic diseases, and they're a violinist,
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and this is a violinist, and he's concerned
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that it's due to overplaying or overuse of the
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elbow because they were practicing too much."
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very much.
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And then he said, "Well, what about the sister?
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Does the sister have it?"
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And I said, "The sister?"
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And lo and behold, I open up
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the next brachial plexus, and lo and
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behold, it's the sister as well, too.
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So now in the sister, again, lots
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of enlarged lymph nodes in the
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non-contrast T1-weighted image.
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When we look at this collapsed
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image, again, we see multiple lymph
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nodes involving the left axilla.
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And I remember I specifically asked the patient,
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I said, "Is it possible they had a COVID vaccine?"
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And the surgeon said, "There's no
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history that they had the COVID vaccine."
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So anyway, I went ahead and dictated out.
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And again, I was a little
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bit concerned about this,
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potentially being associated
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with the COVID vaccine.
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And then it turns out when our team called up
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the parents, both of these kids had had their
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recent COVID vaccine about three weeks ago.
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And this was likely due to an
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association with the COVID vaccine.
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We can see the enlarged lymph nodes
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and a little bit of increased signal
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involving the cords of the brachial plexus.
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Now, I don't want to say that this is
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a complication of the COVID vaccine.
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This was just an association.
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Personally, I've had two doses,
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and then I've had three boosters.
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So, I've actually had five of the vaccinations.
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So, the COVID vaccine is safe.
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You should always get it.
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But occasionally, as we all know, you
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can have COVID-associated lymphadenopathy
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involved in the axillary region.
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So this is just one of the
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effects of the COVID vaccine.
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And in this particular case, this was
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associated with ipsilateral enlarged lymph nodes
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resulting in slight brachial plexus neuritis.
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