Have You Recently Had The Vaccine?

A 37-year-old woman developed a new, palpable left supraclavicular lymphadenopathy lump five days after her first dose of the Moderna COVID-19 vaccine in the left arm. On the day of vaccination, the patient was asymptomatic. This is an example of how the vaccine can mimic cancer and swollen lymph nodes.  Image used with permission of RSNA.

While the mass COVID-19 vaccination effort over the past four months is bringing closer the light at the end of the pandemic tunnel, as with all things in medicine, it is not without a cost. But the cost here will be in terms of added patient anxiety and financial due to potential of additional, needed tests. There have been several alarms in peer-review literature and radiology societies the past couple months that the COVID-19 vaccines cause temporary inflammation and swelling of lymph nodes in some patients. While the experts say this is normal, it can be a major cause for concern if physicians, radiologists and patients are not aware of this vaccine presentation and assume it is a sign of infection or cancer, leading to additional diagnostic testing or followup exams.

Lymphadenopathy, also called adenopathy, is when lymph nodes are abnormal in size or consistency. The most common inflammatory type is lymphadenitis, producing swollen or enlarged lymph nodes. However, it is causing alarm on mammograms of recently vaccinated women and can lead to additional tests and imaging if found in patients who undergo CT scans for any reason.

The development of lymphadenopathy after being vaccinated for COVID-19 is a sign of the body’s immune system gearing up in response to the vaccine and will go away, the experts say.[1,2] It has been seen with other vaccines for the influenza and human papillomavirus, but the two-dose Pfizer-BioNTech and Moderna COVID vaccines appear to affect a much larger number of people. In the clinical trials for the the Moderna vaccine, axillary swelling or tenderness was reported in 11.6% of patients (5% with placebo) after dose 1, and 16% (4.3% with placebo) after Dose 2.[3] This greatly concerns radiologist who look at mammograms and review exams looking for cancer, or monitoring cancer treatment in patients.

This concern prompted an editorial in the Radiological Society of North America (RSNA) journal Radiology: Imaging Cancer published April 9 that addresses the concerns and the diagnostic dilemma for patients, as lymphadenopathy can mimic cancer on imaging exams.[4] The authors of “COVID-19 Vaccination-Related Lymphadenopathy: What To Be Aware Of” point out that widespread patient education regarding vaccine-induced lymphadenopathy is needed. When vaccines are administered, side effects such as axillary swelling should be highlighted and normalized as an immune response initiated by the vaccine, they explain. The article also touches on the best times for patients to schedule imaging exams and offers follow-up recommendations.

“We write this editorial as a public service message at a time where other countries are starting mass vaccination programs with the goal of preventing unnecessary nodal biopsies and alleviating patient concern,” the authors wrote. “Imaging societies, clinicians and news media outlets should spread awareness to educate the public regarding this side effect to minimize patient anxiety.”

With mass vaccination rollout, the authors of the article said lymphadenopathy ipsilateral to the injected deltoid muscle has become an important manifestation of an immune response to be aware of as it may present as a diagnostic dilemma on cancer imaging studies. They said awareness will help the goal of preventing unnecessary nodal biopsies and alleviating patient concerns.

The article details the issue, what can be done and recaps the peer-review literature to date and guidelines issues since the start of vaccinations last December.

Breast imaging exams, screening mammography, breast ultrasound and breast MRI, can all show the presence of swollen lymph nodes. This has raised concerns and led to recommendations that women should be asked it they have received a COVID-19 vaccine prior to imaging exams.

This prompted the Society of Breast Imaging (SBI) to quickly issue recommendations for when to image women who receive the COVID vaccine.[5] Recommendations were also published by women’s health imaging specialists at Harvard Medical School and the Massachusetts General Hospital Department of Radiology.[6]

In a recent American Journal of Roentgenology (AJR) article, Shabnam Mortazavi, M.D., of the University of California at Los Angeles reviewed electronic medical records to identify women with post-COVID-19 vaccination adenopathy found in breast imaging between December 2020 to February 2021.[7] Twenty-three women exhibited axillary adenopathy ipsilateral to the vaccinated arm on screening or diagnostic breast imaging, and according to Mortazavi, “13% were symptomatic (axillary lump with possible tenderness).” Meanwhile, the adenopathy was detected incidentally on screening breast imaging in 43% (mammography, 5; ultrasound, 2; both mammography and ultrasound, 1; high-risk screening MRI, 2) and on diagnostic imaging for other reasons in 43% (BI-RADS 3 follow-up for breast finding, 3; screening callback for other reason, 2; non-axillary breast pain or lump, 5). Noting that the median interval between the first vaccine dose and imaging showing the abnormal node was 9.5 days, Mortazavi’s results counted a total of 57% of women with one abnormal node. BI-RADS 2 was assigned in one woman, BI-RADS 3 in 21 (ultrasound in 4–24 weeks), and BI-RADS 4 in one.

To Schedule and Exam for Yourself or a Friend Call

(714) 363-5595 or go to www.ocbreastwellness.com and click on SCHEDULE