SYRACUSE, NY – Earlier this year, the medical imaging department at Crouse Hospital began noticing an increase in enlarged lymph nodes in patients’ armpits during routine breast examinations.
Normally, this is a concern.
“An enlarged lymph node may be a flag for cancer,” said Dr. David Wang, medical director of Crouse, said. “But an enlarged lymph node can also be seen with infection or any inflammatory process that is going on.”
Led by similar reports circulating among other radiologists, Crouse technicians began asking patients, ‘Have you recently had a vaccine against Covid-19? Which arm? ”
Bingo.
Swelling of lymph nodes appears to be relatively common side effect of the Covid vaccines, such as fever, chills and fatigue. Instead of first stopping the metastasis of cancer cells, the enlarged nodules merely revealed that the lymphatic system was doing its job as part of the body’s immune arsenal, which had mobilized to fight the new coronavirus.
“It’s really a typical reaction,” Wang said. ‘The side that gets the chance is the side where the lymph nodes are enlarged. The other side looks completely normal. ”
Wang and his staff even saw it in themselves: all five members of the imaging department found that they had a slight swelling of the lymph nodes after their vaccinations, always under the arm that received the shot.
According to Wang, he grew larger after the second dose of Moderna vaccine, which he received about eight weeks ago. The knot gradually shrank, he said.
The reaction is common in men and women, he said, and can be seen not only in mammograms and ultrasounds of the breast, but also in MRIs and CT scans. The magnification may vary. Lymph nodes are usually about a quarter to a half inch long, but can double in size when fighting an infection or responding to the vaccine.
Crouse added a section to his paperwork to ask patients if they had the Covid-19 vaccine and in what arm. It helps relieve patients’ anxiety when an enlarged node is spotted, and reduces the need to perform further tests, which is common if a swollen node can suggest cancer.
The Society for Breast Imaging recommended that women take their exams before receiving the vaccine or wait four weeks after the final dose. (Pfizer and Moderna need two strokes; Johnson & Johnson, just one.)
However, Crouse recommends that women stay on their regular schedule, rather than postponing the vaccine or mammogram.
“If you can get a mammogram before you get the vaccine, there are no problems,” Wang said, “but if you do get the vaccine, you can still get your mammogram, and we’ll take it into account. We did not want to discourage people from following their normal performances. ”
If a patient has an enlarged nodule near a recent vaccine injection site, Wang is advised to monitor it for eight weeks. If it does not go away or still looks abnormal, Wang said, more tests may be needed.
“If there is any concern that it may be anything other than a reaction to the vaccine,” he said, “we will say, ‘Let’s look again in eight weeks. ”
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