Gullotti David M, Lipson Evan J, Fishman Elliot K, Rowe Steven P
The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Radiology Room 118, 21287 Baltimore, MD, USA.
Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Radiol Case Rep. 2022 Mar;17(3):878-880. doi: 10.1016/j.radcr.2021.12.002. Epub 2022 Jan 10.
As the administration of COVID-19 vaccines continues to increase, so too does awareness of the associated ipsilateral axillary lymphadenopathy. This has created a diagnostic challenge in the field of radiology, in particular among patients with cancer, as post-vaccination reactive adenopathy has been reported to be mistakenly interpreted as malignancy. As radiology departments improve their protocols for obtaining vaccine-related patient history, and radiologists become acclimated to attributing axillary lymphadenopathy to recent COVID-19 vaccination, there is a risk of the pendulum swinging too far and under-diagnosing true oncologic disease. This report describes an otherwise healthy 53-year-old man who presented with discomfort due to ipsilateral axillary lymphadenopathy shortly after receiving a COVID-19 vaccine. Fine needle aspiration performed within 2 months of receiving the vaccine revealed metastatic melanoma and subsequent F-FDG PET/CT demonstrated intensely avid axillary and supraclavicular adenopathy without visualization of a primary lesion. This case serves as a cautionary report to remind clinicians to remain suspicious of possible underlying malignancy with the presence of axillary adenopathy, despite a history of recent COVID-19 vaccination.
随着新冠病毒疫苗接种量的持续增加，人们对相关同侧腋窝淋巴结病的认识也在提高。这给放射学领域带来了诊断挑战，尤其是在癌症患者中，因为据报道接种疫苗后的反应性淋巴结病会被误诊为恶性肿瘤。随着放射科改进获取与疫苗相关患者病史的方案，且放射科医生逐渐习惯将腋窝淋巴结病归因于近期的新冠病毒疫苗接种，存在一种风险，即可能走向另一个极端，漏诊真正的肿瘤疾病。本报告描述了一名53岁的健康男性，在接种新冠病毒疫苗后不久，因同侧腋窝淋巴结病出现不适。在接种疫苗后2个月内进行的细针穿刺显示为转移性黑色素瘤，随后的F-FDG PET/CT显示腋窝和锁骨上淋巴结病呈高度摄取，未发现原发灶。该病例作为一份警示报告，提醒临床医生，尽管有近期新冠病毒疫苗接种史，但在出现腋窝淋巴结病时，仍要怀疑可能存在潜在恶性肿瘤。
