49-year-old woman recalled for asymmetry in left breast and large left axillary lymph node
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Our next patient is a 49-year-old woman
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recalled from screening, both for evaluation
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of an asymmetry in the left breast and for
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evaluation of a large left axillary lymph node.
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These are the screening mammogram views.
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For this patient, and there was a little
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asymmetry right here in the medial breast
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on the CC view, and then you can see
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this large lymph node in the left axilla.
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Blow that up a little bit, you know,
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sort of a big, thick lymph node.
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And it was larger than it
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had been on prior mammograms.
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And then this little asymmetry was new.
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So when she came back, she had a workup
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for the asymmetry, which included spot
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compression and lateral views, and then
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ultrasound, which was the little area on spot
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compression, little micro lobulated mass.
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So she had her ultrasound, just to show you that
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area of asymmetry, there was a little cluster
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of cysts here that we weren't too worried about.
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But in the axilla, she had this very
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large lymph node with a very thick cortex,
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up to eight millimeters in thickness.
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And there was a second one that was large,
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we found there were a couple
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others that were large as well.
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So at least two big lymph nodes.
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And then we questioned the patient some more,
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and we found out that she had had a COVID-19 vaccine
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administered to the left arm three weeks earlier.
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And we thought that this was almost certainly
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reactive and related to the COVID-19 vaccine.
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And at that time, we were following at
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three-month intervals, so we recommended
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three-month follow-up for that lymph node.
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And that was the recommendation at the time.
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Because this was early 2021.
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Ultimately, this lymph node didn't really
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change very much in size on follow-up, and a
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decision was made to do a lymph node biopsy.
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And there was some family history of
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breast cancer, so the patient was worried.
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And the biopsy was done and
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showed a reactive lymph node.
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So we think this was all related to the
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COVID-19 vaccine that the patient had.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
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