Ipsilateral axillary lymphadenopathy is a well-documented finding associated with COVID-19 vaccination. Varying guidelines have been published for the management of asymptomatic patients with history of recent vaccination who present with incidental lymphadenopathy on screening mammography. Some experts recommend follow-up imaging, while others suggest that clinical management, rather than repeat imaging or biopsy, is appropriate. Patients with symptomatic lymphadenopathy and/or additional abnormal imaging findings should be managed differently depending on risk factors and clinical scenarios. While ipsilateral lymphadenopathy is well documented, ipsilateral breast edema after COVID-19 vaccination has been rarely reported. The combination of ipsilateral lymphadenopathy and diffuse breast edema after COVID-19 vaccination presents a clinical management challenge, as edema may obscure underlying abnormalities on imaging. We propose that, in patients with symptomatic lymphadenopathy and associated breast parenchymal abnormality, prompt action is appropriate, including diagnostic evaluation and consideration for tissue sampling. This approach may prevent delays in diagnosis and treatment for patients with malignancy masked by symptoms from the vaccination.
Management Strategies for Patients Presenting With Symptomatic Lymphadenopathy and Breast Edema After Recent COVID-19 Vaccination.