COVID-19 Vaccination Manifesting as Incidental Lymph Nodal Uptake on 18F-FDG PET/CT

Najeeb Ahmed, Samreen Muzaffar 1, Corinne Binns 2, Muhammad Waqas Ilyas 2, Sharjeel Usmani 3

Affiliations

01 May 2021

-

doi: 10.1097/RLU.0000000000003635

Abstract

Benign uptake on 18F-FDG PET can be seen with inflammatory conditions. We report a case of an 86-year-old woman with successfully treated nasal melanoma who underwent routine follow-up 18F-FDG PET, day 6 after the second dose of Pfizer-BioNTech COVID-19 vaccine inoculated in the left deltoid muscle. 18F-FDG PET showed increase tracer uptake in the left deltoid muscle and in 2 normal-sized left subpectoral nodes. These findings were considered secondary to vaccination. With the current drive of global COVID-19 immunization, this case highlights the importance of documenting vaccination history at the time of scanning to avoid false-positive results.

Conflict of interest statement

Conflicts of interest and sources of funding: none declared.

Similar articles

18F-FDG-Avid Lymph Nodes After COVID-19 Vaccination on 18F-FDG PET/CT.

Ulaner GA, Giuliano P.Clin Nucl Med. 2021 May 1;46(5):433-434. doi: 10.1097/RLU.0000000000003633.PMID: 33782318

COVID-19 Vaccine-Related Local FDG Uptake.

Doss M, Nakhoda SK, Li Y, Yu JQ.Clin Nucl Med. 2021 May 1;46(5):439-441. doi: 10.1097/RLU.0000000000003634.PMID: 33661194

Frequency and Characteristics of Nodal and Deltoid FDG and 11C-Choline Uptake on PET Performed After COVID-19 Vaccination.

Schroeder DG, Jang S, Johnson DR, Takahashi H, Navin PJ, Broski SM, Thorpe MP, Johnson GB, Young JR.AJR Am J Roentgenol. 2021 Nov;217(5):1206-1216. doi: 10.2214/AJR.21.25928. Epub 2021 May 19.PMID: 34009000

COVID-19 Vaccination-Related Uptake on FDG PET/CT: An Emerging Dilemma and Suggestions for Management.

McIntosh LJ, Bankier AA, Vijayaraghavan GR, Licho R, Rosen MP.AJR Am J Roentgenol. 2021 Oct;217(4):975-983. doi: 10.2214/AJR.21.25728. Epub 2021 Mar 1.PMID: 33646823 Review.

Lymphadenopathy post-COVID-19 vaccination with increased FDG uptake may be falsely attributed to oncological disorders: A systematic review.

Bshesh K, Khan W, Vattoth AL, Janjua E, Nauman A, Almasri M, Mohamed Ali A, Ramadorai V, Mushannen B, AlSubaie M, Mohammed I, Hammoud M, Paul P, Alkaabi H, Haji A, Laws S, Zakaria D.J Med Virol. 2022 May;94(5):1833-1845. doi: 10.1002/jmv.27599. Epub 2022 Feb 7.PMID: 35060149 Free PMC article. Review.

Cited by

Ipsilateral Upper-Limb Lymphedema After COVID-19 Vaccine Booster.

Tang CYL, Chua WM.Clin Nucl Med. 2023 Mar 1;48(3):264-265. doi: 10.1097/RLU.0000000000004470. Epub 2022 Oct 27.PMID: 36302077 Free PMC article.

Bilateral Axillary Nodal Uptake on 99m Tc-White Blood Cell Study Secondary to COVID-19 mRNA Vaccination.

Namous NA, Kushner D, Dadparvar S.Clin Nucl Med. 2023 Mar 1;48(3):250-252. doi: 10.1097/RLU.0000000000004394. Epub 2022 Sep 21.PMID: 36127779 Free PMC article.

Increased 18F-FDG Uptake in the Axillary Lymph Nodes of the Vaccinated Side Associated with COVID-19 Vaccination.

Otomi Y, Irahara S, Inoue H, Shinya T, Otsuka H, Harada M.Mol Imaging Radionucl Ther. 2022 Jun 27;31(2):169-171. doi: 10.4274/mirt.galenos.2021.22590.PMID: 35771098 Free PMC article.

[18F]FDG uptake in axillary lymph nodes and deltoid muscle after COVID-19 mRNA vaccination: a cohort study to determine incidence and contributing factors using a multivariate analysis.

Kubota K, Saginoya T, Ishiwata K, Nakasato T, Munechika H.Ann Nucl Med. 2022 Apr;36(4):340-350. doi: 10.1007/s12149-021-01711-7. Epub 2022 Jan 31.PMID: 35098436 Free PMC article.

The incidence and duration of COVID-19 vaccine-related reactive lymphadenopathy on 18F-FDG PET-CT.

El-Sayed MS, Wechie GN, Low CS, Adesanya O, Rao N, Leung VJ.Clin Med (Lond). 2021 Nov;21(6):e633-e638. doi: 10.7861/clinmed.2021-0420.PMID: 34862224 Free PMC article.

KMEL References

https://pubmed.ncbi.nlm.nih.gov/

References

  1.  
    1. Fletcher JW, Djulbegovic B, Soares HP, et al. Recommendations on the use of 18F-FDG PET in oncology. J Nucl Med. 2008;49:480–508.
  2.  
    1. Stumpe KD, Dazzi H, Schaffner A, et al. Infection imaging using whole-body FDG-PET. Eur J Nucl Med. 2000;27:822–832.
  3.  
    1. Shirone N, Shinkai T, Yamane T, et al. Axillary lymph node accumulation on FDG-PET/CT after influenza vaccination. Ann Nucl Med. 2012;26:248–252.
  4.  
    1. Coates EE, Costner PJ, Nason MC, et al. Lymph node activation by PET/CT following vaccination with licensed vaccines for human papillomaviruses. Clin Nucl Med. 2017;42:329–334.
  5.  
    1. Panagiotidis E, Exarhos D, Housianakou I, et al. FDG uptake in axillary lymph nodes after vaccination against pandemic (H1N1). Eur Radiol. 2010;20:1251–1253.
  6.  
    1. Ayati N, Jesudason S, Berlangieri SU, et al. Generalized lymph node activation after influenza vaccination on 18F FDG-PET/CT imaging, an important pitfall in PET interpretation. Asia Ocean J Nucl Med Biol. 2017;5:148–150.
  7.  
    1. Burger IA, Husmann L, Hany TF, et al. Incidence and intensity of F-18 FDG uptake after vaccination with H1N1 vaccine. Clin Nucl Med. 2011;36:848–853.
  8.  
    1. Williams G, Joyce RM, Parker JA. False-positive axillary lymph node on FDG-PET/CT scan resulting from immunization. Clin Nucl Med. 2006;31:731–732.

Page Navigation