No abstract

The UK COVID vaccination programme has progressed at an astonishing rate since the first patients received their doses in December 2020. It is well known that other vaccines including influenza and human papilloma virus (HPV) can result in reactive lymphadenopathy in the axilla and/or neck. Patients are now presenting via the two week wait neck lump clinic with supraclavicular fossa and low neck lymphadenopathy related to COVID vaccination, and to similar one stop breast clinics with axillary lymph nodes. In an audit of 80 patients seen over a period of one month, we found COVID vaccine-related low neck lymphadenopathy in four cases (5%), with an additional rectal cancer patient thought to have metastatic disease who presented with a Virchow type node. COVID vaccine-related lymphadenopathy should be considered in the differential diagnosis of low-neck nodes if they occurred shortly after vaccination, but it is important to exclude sinister disease using ultrasound and other investigations as necessary.

Introduction U-score ultrasound classification (graded U1-U5) is widely used to grade thyroid nodules based on benign and malignant sonographic features. It is well established that ultrasound is an operator-dependent imaging modality and thus more susceptible to subjective variances between operators when using imaging-based scoring systems. We aimed to assess whether there is any intra- or interobserver variability when U-scoring thyroid nodules and whether previous thyroid ultrasound experience has an effect on this variability. Methods A total of 14 ultrasound operators were identified (five experienced thyroid operators, five with intermediate experience and four with no experience) and were asked to U-score images from 20 thyroid cases shown as a single projection, with and without Doppler flow. The cases were subsequently rescored by the 14 operators after six weeks. The first and second round U-scores for the three operator groups were then analysed using Fleiss’ kappa to assess interobserver variability and Cochran’s Q test to determine any intraobserver variability. Results We found no significant interobserver variability on combined assessment of all operators with fair agreement in round 1 (Fleiss’ kappa = 0.30, p <0.0001) and slight agreement in round 2 (Fleiss’ kappa = 0.19, p < 0.0001). Cochran’s Q test revealed no significant intraobserver variability in all 14 operators between round 1 and round 2 (all p>0.05). Conclusions We found no statistically significant inter- or intraobserver variability in the U-scoring of thyroid nodules between all participants reinforcing the validity of this scoring method in clinical practice, allaying concerns regarding potential subjective biases in reporting.

SUMMARYA 37-year-old man presented with an abnormal pharyngeal sensation. Nasendoscopy demonstrated a mass projecting from the left pharyngeal wall, which could be pushed medially with external pressure. A CT scan demonstrated a fracture of the hyoid. On further questioning, the patient stated that he practised Jujitsu, a sport involving various strangling manoeuvres. He underwent a pharyngoscopy and out-fracturing of the hyoid, resulting in complete resolution of his symptoms. Hyoid fractures are uncommon and can be difficult to identify clinically, but the serious nature of associated complications highlights the importance of making the diagnosis. BACKGROUND