Quadrilateral space region inflammation and other incidental findings on shoulder MRI following recent COVID-19 vaccination: Three case reports

Eisenberg, Matthew T; Tingey, Christopher; Fulton, Oliver; Owen, Joshua B.; Snyder, Travis

doi:10.1016/j.radcr.2021.07.028

Cited by 4 publications

(7 citation statements)

References 16 publications

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“…The number of visible axillary lymph nodes in both areas was significantly higher in the vaccine group (median [range], 15 nodes ) than in the metastasis group (7 nodes [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]) (Table 2). The median and range of the short lymphadenopathy diameter in the ventral side of the axilla were significantly larger in the metastasis group (8.0 mm [5.5-22.5]) than in the vaccine group (6.4 mm [5.2-10.0]).…”

Section: Resultsmentioning

confidence: 99%

“…Level I lymph nodes are divided into three groups: the pectoral (anterior), subscapular (posterior), and humeral (lateral) groups [ 10 , 14 , 15 ]. There are no previous reports on the lymphatic pathway from the deltoid muscle; therefore, details regarding this pathway are not yet known [ 16 , 17 ]. Breast lymphatic drainage predominantly occurs into the pectoral (anterior) group of level I lymph nodes, while upper extremity lymphatic drainage predominantly occurs into the humeral (lateral) group of these lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

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The location of unilateral axillary lymphadenopathy after COVID-19 vaccination compared with that of metastasis from breast cancer without vaccination

et al. 2023

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Purpose Unilateral axillary lymphadenopathy is known to occur after coronavirus disease (COVID-19) vaccination. Post-vaccination lymphadenopathy may mimic the metastatic lymph nodes in breast cancer, and it is challenging to distinguish between them. This study investigated whether the localization of axillary lymphadenopathy on magnetic resonance imaging (MRI) could be used to distinguish reactive lymphadenopathy after COVID-19 vaccines from metastatic nodes. Materials and methods We retrospectively examined preoperative MRI images of 684 axillae in 342 patients who underwent breast cancer surgery from June to October 2021. Lymphadenopathy was defined as cortical thickening or short axis ≥ 5 mm. The axilla was divided into ventral and dorsal parts on the axial plane using a perpendicular line extending from the most anterior margin of the muscle group, including the deltoid, latissimus dorsi, or teres major muscles, relative to a line along the lateral chest wall. We recorded the presence or absence of axillary lymphadenopathy in each area and the number of visible lymph nodes. Results Of 80 axillae, 41 and 39 were included in the vaccine and metastasis groups, respectively. The median time from the last vaccination to MRI was 19 days in the vaccine group. The number of visible axillary lymph nodes was significantly higher in the vaccine group (median, 15 nodes) than in the metastasis group (7 nodes) (P < 0.001). Dorsal lymphadenopathy was observed in 16 (39.0%) and two (5.1%) axillae in the vaccine and metastasis groups, respectively (P < 0.001). If the presence of both ventral and dorsal lymphadenopathy is considered indicative of vaccine-induced reaction, this finding has a sensitivity of 34.1%, specificity of 97.4%, and positive and negative predictive values of 93.3％ and 58.5%, respectively. Conclusion The presence of deep axillary lymphadenopathy may be an important factor for distinguishing post-vaccination lymphadenopathy from metastasis. The number of axillary lymph nodes may also help.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The location of unilateral axillary lymphadenopathy after COVID-19 vaccination compared with that of metastasis from breast cancer without vaccination

et al. 2023

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“…It is established that vaccine administration leads to a local inflammatory response in a certain number of cases, involving injection site muscles and the lymphnodes afferent to the injection site. Therefore, this is responsible of the increased 18 FDG uptake of axillary lymphnodes on the PET-CT [9] .…”

Section: Discussionmentioning

confidence: 99%

COVID-19 vaccination simulating lymph node progression in a patient with prostate cancer

Andresciani

Ricci

Grasso

et al. 2022

Radiology Case Reports

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“… Six weeks and three months after discharge, inspection showed that the pain disappeared, the shoulder joint effusion subsided, and the shoulder joint range of motion was normal. 2 1 21 Male Pfizer-BioNTech COVID-19 vaccination First Fifteen hours after receiving vaccination Not record Swelling sensation in the armpit, mild swelling in the neck lymph nodes, and mild tenderness in the injection area. Not record MRI showed secondary deltoid edema and mild inflammation in the axillary area.…”

Section: Methodsmentioning

confidence: 99%

An analysis of reported cases shoulder injury related to vaccine administration of after COVID-19 vaccination

Li,

Chen,

Zhao

2024

Human Vaccines & Immunotherapeutics

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To prevent COVID-19, the COVID-19 vaccine has been widely administered worldwide, but various complications accompany this vaccine. The aim of this study was to investigate the demographic patterns, clinical features, diagnostic findings, and treatment outcomes associated with shoulder injury related to vaccine administration (SIRVA). This study examined 22 patients with SIRVA following COVID-19 vaccination from the Web of Science (WOS) and PubMed databases. The patients were categorized based on sex, age, type of COVID-19 vaccine received, dose administered, latency of symptom onset, and the presence of specific clinical manifestations. Patients, evenly distributed by sex (12 females, 10 males), and aged 21 to 84 years (mean age 46.6), were analyzed. SIRVA cases were reported across all age groups. The Pfizer – BioNTech COVID-19 vaccine had the highest incidence ( n = 8), followed by the Oxford/AstraZeneca COVID-19 vaccine ( n = 4). Symptoms, primarily shoulder pain ( n = 22) and shoulder mobility disorders ( n = 18), occurred within three days post-vaccination. Some patients also reported shoulder swelling ( n = 5) and fever ( n = 2). Imaging revealed nonspecific X-ray findings, supraspinatus tendon calcification ( n = 2), and shoulder edema and inflammation on MRI ( n = 12). This study provides insights into the clinical aspects of SIRVA related to COVID-19 vaccination. Recognition and appropriate management of these complications are crucial for optimal patient outcomes.

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Quadrilateral space region inflammation and other incidental findings on shoulder MRI following recent COVID-19 vaccination: Three case reports

Cited by 4 publications

References 16 publications

The location of unilateral axillary lymphadenopathy after COVID-19 vaccination compared with that of metastasis from breast cancer without vaccination

The location of unilateral axillary lymphadenopathy after COVID-19 vaccination compared with that of metastasis from breast cancer without vaccination

COVID-19 vaccination simulating lymph node progression in a patient with prostate cancer

An analysis of reported cases shoulder injury related to vaccine administration of after COVID-19 vaccination

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