#SHOTTY LYMPH NODES NORMAL SKIN#
#SHOTTY LYMPH NODES NORMAL TRIAL#

(α) The initial diagnosis of CEUS was based on centripetal perfusion enhancement in the asynchronous type, with a notable area in the deviated center showing hypoperfusion, covering half of the area of the lymph node. (D) The last US showed normalized lymph node (indicated by hollow arrows). (C) The third US in the follow-up showed a distinctive decrease in lymph node size and cortical thickness having irregular shape. (B) The second US showed indistinctive decrease in cortical thickness and the same lymph node size from the previous examination. The lymphatic cortex was notably thickened to 12 mm and presented as a homogeneous hypoechoic area with a visible lymphatic hilum. (A) The initial US showed the lymph node was in deep position, flat oval in shape, 40 mm on the long axis and 15 mm on the short axis, with a long/short ratio of >2. The puncture site was fully recovered, but the abnormal lymph nodes never demonstrate a remission.įigure 1 Successive ultrasonography (US) and contrast-enhanced ultrasonography (CEUS) images of the same largest lymph node, with dynamic changes during progression and regression. Thus, tuberculosis and malignancy were excluded, lymphadenopathy was inferred to be bacterial, and treatment with cefaclor (750 mg per os, twice daily for 7 days) was given. A US-guided fine-needle aspiration ( Figure 2D) of one abnormal lymph node (different to the largest one) was performed to confirm the diagnosis however, the Xpert MTB/RIF assay was negative for the tuberculous gene, the cell smear demonstrated neutrophils and lymphocytes, and the T-cell spot (T-SPOT TB) test and purified protein derivative test were also negative. The sign was misinterpreted as an alarming “necrotic” change and “evidence” of tuberculosis. Contrast-enhanced ultrasonography (CEUS) using SonoVue (sulfur hexafluoride microbubbles, Bracco, Netherlands) revealed an internal hypoperfusion area ( Figure 1α). The relevant diagnostic workup revealed the following: complete blood count (CBC) demonstrated a slight decrease in eosinophils (0.01 × 10 9/L), the computed tomography (CT) of the head, neck, and chest was normal, and the US of the thyroid, breast, and lymph nodes in other parts of the body and abdomen was also normal ( Figure 2E). Ultrasonography (US) revealed multiple abnormal left axillary lymph nodes with “alarming” signs ( Figures 1A, 2A–C).

#SHOTTY LYMPH NODES NORMAL SKIN#

Physical examination revealed left axillary swelling and tenderness with no localized skin or soft tissue lesions, particularly on the head, neck, chest, or left arm. The possibility of side effects was neglected, as the detection exceeded the expected time interval for an adverse reaction to the vaccine. She received the first and second doses of CoronaVac 5 and 4 months ago, respectively, with both doses delivered to the left deltoid muscle. She denied a medical history of allergic disease, tuberculosis, past malignant tumors, recent infection, trauma, specific medication history, and travel or social history. Case DescriptionĪ 34-year-old woman presented with left axillary pain for a week and transient fever (38.6☌) for a day. We highlight its prolonged course, discuss the clinical findings and imaging features, and analyze our misdiagnosis in combination with a relevant literature review.

Herein we present a misdiagnosed case of remote lymphadenopathy after receiving the CoronaVac vaccine from Sinovac. This side effect is a frequent finding after COVID-19 vaccination. The frequency of imaging-detected lymphadenopathy ranged between 14.5 and 53% ( 12).

The Centers for Disease Control and Prevention of the United States (CDC) have reported 11.6 and 16.0% of axillary swelling or tenderness after receiving the first and second doses of Moderna, respectively ( 11). In reality, the rate is likely to be higher. Additionally, it has been reported to be rare in the trials of Moderna, Novavax, Sinovac, Johnson & Johnson, and AstraZeneca vaccines ( 6– 10).

#SHOTTY LYMPH NODES NORMAL TRIAL#

Reactive hyperplasia of the ipsilateral axillary lymph nodes is a side effect of vaccination ( 3), which has been reported in 0.3% of the participants in the clinical trial of Pfizer ( 4, 5). As of February 10, 2022, 10.3 billion doses of the vaccines have been administered globally ( 2). Globally, large-scale COVID-19 vaccination programs are in progress to control the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic ( 1).

Shotty lymph nodes normal