0:00

This was a screening mammogram that was performed on a patient who had

0:05

a COVID 19 vaccine one week previously. The vaccine was done in the

0:10

right arm and on her MLO view, we noticed that there was what looked

0:16

like an enlarged lymph node that's partially visualized up here in the right

0:20

axilla. So the patient was given a BI RADS 0 and recommended to

0:25

come back for a diagnostic ultrasound exam. These are the images from the

0:30

ultrasound. So we do see this lymph node,

0:34

which has some cortical thickening measuring up to four millimeters. Three

0:40

millimeters is typically our cutoff for a lymph node.

0:45

Because this was so soon after her COVID 19 vaccine, we followed the

0:50

SBI recommendation and recommended for her to come back for

0:54

a short term follow up to see if this resolved.

0:59

When she came back, this was right at 12 weeks after her second

1:03

vaccine. So we would expect the vaccine related adenopathy to resolve.

1:10

We actually saw that the lymph node had gotten a little bit bigger.

1:20

So now that, again, we see some of the cortical thickening

1:26

measuring up to five or six millimeters and it looks like there's actually

1:30

some eccentric cortical thickening here. This was then recommended for a

1:35

biopsy and patient was diagnosed with CLL. This is unusual to have unilateral

1:43

adenopathy with CLL, but it can happen. And this is a reason that

1:47

we want to make sure we're following these patients to resolution of adenopathy,

1:51

even when we think it's possibly related to the timing of a COVID

1:55

vaccine. So this was a patient who was recalled from screening mammogram

2:00

for axillary adenopathy. We did see some cortical thickening on her follow

2:05

up. We thought because of the timing, so close to her COVID vaccine,

2:10

it was likely reactive. Did not resolve at the 12 week follow up appointment

2:15

and biopsy did show CLL. So this is just a good reminder and

2:21

this is a new topic and may be evolving, but this is what

2:25

the current guidelines are recommending that we do.