Axillary adenopathy following COVID-19 vaccination: A single institution case series

Abstract

Axillary adenopathy is a potential side effect following COVID-19 vaccination. We report four cases of axillary adenopathy in the setting of recent COVID-19 vaccination (Moderna and Pfizer-BioNTech) at our institution. Our cases show unilateral axillary adenopathy, as well as adenopathy persisting for two to three weeks following vaccination. The Society of Breast Imaging (SBI) and Harvard University have each released guidelines for management of axillary adenopathy following COVID-19 vaccination. While SBI recommends short term imaging 4–12 weeks following the second dose, a group of physicians from Harvard suggest clinical follow-up with sonographic imaging if clinical concern persists beyond six weeks. As a larger percentage of the general population becomes vaccinated, it is important for radiologists to be aware of potential vaccine-induced ipsilateral axillary adenopathy on screening and diagnostic breast imaging to reduce the number of unnecessary biopsies performed in this patient population.

Emergency room imaging findings in patients presenting after COVID-19 vaccination

“…Cervical/axillary lymphadenopathy, seen in 36.6% of positive studies, may represent a common side effect of vaccination, a finding concordant with other previously published studies reporting lymphadenopathy (including FDG-avid lymph nodes) following COVID-19 vaccination. [ 12 , 14 ] A few studies demonstrated more serious/critical findings (i.e., complicated diverticulitis with abscess, pulmonary embolus, septic arthritis, spinal cord lesion, and vertebral artery occlusion). Vascular post-vaccine complications are considered the most dangerous complications.…”

“…[ 10 ] Because of the rapid rollout, data and literature on the full range of vaccine side effects and potential complications remain limited. [ 11 , 12 ] Just as the disease itself is associated with a wide variety of clinical presentations, post-disease manifestations, and unexpected complications, the COVID-19 vaccine has been accompanied by some unexpected side effects, some of which have resulted in emergency room (ER) presentations.…”

COVID-19 Vaccine-Associated Lymphadenopathy in Breast Imaging Recipients: A Review of Literature

“…The most important factors were younger patients and shorter time intervals from receiving the second dose of the vaccine. 18 Duke et al [ 27 ] Axillary adenopathy following COVID-19 vaccination: a single-institution case series Case series on four patients with axillary adenopathy on routine screening breast imaging in the setting of recent COVID-19 vaccination (Moderna and Pfizer-BioNTech). Cases show unilateral axillary adenopathy, as well as adenopathy persisting for two to three weeks following vaccination.…”