Unilateral Lymphadenopathy After COVID-19 Vaccination: A Practical Management Plan for Radiologists Across Specialties.
Unilateral Lymphadenopathy After COVID-19 Vaccination: A Practical Management Plan for Radiologists Across Specialties.
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DOI：
10.1016/j.jacr.2021.03.001
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发表时间：
2021-06
期刊：
影响因子：
--
通讯作者：
Lamb LR
中科院分区：
文献类型：
--
作者：
Lehman CD;D'Alessandro HA;Mendoza DP;Succi MD;Kambadakone A;Lamb LR
最近接种2019年冠状病毒疫苗后，有越来越多的报告称，在各种成像检查中可以看到单侧腋窝淋巴结病的患者。由于只有不到10%的美国人口完全接种了疫苗，我们现在可以准备好为最近接种疫苗后成像的患者提供知情护理。作者建议在接种表格上记录接种信息(接种日期[S][S]，注射地点[左或右，手臂或大腿]，疫苗类型)，并在检查解释时向放射科医生提供这些信息。这些建议基于三个关键因素：疫苗注射的时间和地点、临床背景和成像结果。作者报告了孤立的单侧腋窝淋巴结病(即，在可见淋巴结病之外没有影像表现)，这与最近(之前6周)接种疫苗是同侧的，是良性的，没有进一步的影像显示。建议临床治疗，如果在最后一剂疫苗接种后6周仍存在临床疑虑，则应使用超声波。在进行近期癌症诊断或评估治疗反应的临床环境中，作者鼓励立即推荐成像和疫苗接种(根据已知癌症的位置，可能是在大腿或对侧臂)。在当前癌症诊断的这种临床背景下的管理是针对特定病例量身定做的，理想的情况是肿瘤学治疗团队和放射科医生之间的会诊。这些建议的目的是(1)减少患者的焦虑、提供者的负担，以及在最近的疫苗接种中对增大的结节进行不必要的评估的成本，以及(2)避免疫苗接种和推荐成像的进一步延误，以便在大流行期间提供最佳的患者护理。
Reports are rising of patients with unilateral axillary lymphadenopathy, visible on diverse imaging examinations, after recent coronavirus disease 2019 vaccination. With less than 10% of the US population fully vaccinated, we can prepare now for informed care of patients imaged after recent vaccination. The authors recommend documenting vaccination information (date[s] of vaccination[s], injection site [left or right, arm or thigh], type of vaccine) on intake forms and having this information available to the radiologist at the time of examination interpretation. These recommendations are based on three key factors: the timing and location of the vaccine injection, clinical context, and imaging findings. The authors report isolated unilateral axillary lymphadenopathy (i.e., no imaging findings outside of visible lymphadenopathy), which is ipsilateral to recent (prior 6 weeks) vaccination, as benign with no further imaging indicated. Clinical management is recommended, with ultrasound if clinical concern persists 6 weeks after the final vaccination dose. In the clinical setting to stage a recent cancer diagnosis or assess response to therapy, the authors encourage prompt recommended imaging and vaccination (possibly in the thigh or contralateral arm according to the location of the known cancer). Management in this clinical context of a current cancer diagnosis is tailored to the specific case, ideally with consultation between the oncology treatment team and the radiologist. The aim of these recommendations is to (1) reduce patient anxiety, provider burden, and costs of unnecessary evaluation of enlarged nodes in the setting of recent vaccination and (2) avoid further delays in vaccinations and recommended imaging for best patient care during the pandemic.
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期刊：
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DOI：
10.1056/nejmoa2035389
发表时间：
2021-02-04
期刊：
The New England journal of medicine
影响因子：
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作者：
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