Silicone Granuloma: a Cause of Cervical Lymphadenopathy Following Breast Implantation Amarkumar Dhirajlal Rajgor ‍ ‍ ,1,2 Youssef Mentias,2 Francis Stafford2

Total Page:16

File Type:pdf, Size:1020Kb

Silicone Granuloma: a Cause of Cervical Lymphadenopathy Following Breast Implantation Amarkumar Dhirajlal Rajgor ‍ ‍ ,1,2 Youssef Mentias,2 Francis Stafford2 Case report BMJ Case Rep: first published as 10.1136/bcr-2020-239395 on 3 March 2021. Downloaded from Silicone granuloma: a cause of cervical lymphadenopathy following breast implantation Amarkumar Dhirajlal Rajgor ,1,2 Youssef Mentias,2 Francis Stafford2 1Population Health Sciences SUMMARY painless lumps had been progressively enlarging Institute, Newcastle University, We report a case of a 54-year -old woman with saline- over a 2- week period. She had also been having Newcastle upon Tyne, UK based breast implants who presented to the ear, nose episodes of night sweats but she felt these were 2Otolaryngology & Radiology and throat neck lump clinic with a 2- week history of related to her menopause. She had not noticed Department, Sunderland Royal bilateral neck lumps. She was found to have multiple any other lumps around her body. She denied any Hospital, Sunderland, UK palpable cervical lymph nodes bilaterally in levels IV weight loss and had no head and neck red flag Correspondence to and Vb. The ultrasonography demonstrated multiple symptoms or B- type symptoms. Additionally, she Amarkumar Dhirajlal Rajgor; lymph nodes with the snowstorm sign and a core had no recent viral illness. amar. rajgor@ newcastle. ac. uk biopsy confirmed a silicone granuloma (siliconoma). Thirteen years prior to presentation, she had This granuloma was likely caused by bleeding gel from bilateral breast augmentation with silicone- based Accepted 11 February 2021 the silicone shell of her saline-based implants. This case implants. Three years following insertion, her sili- demonstrates the importance of bleeding gel from saline- cone implants were recalled by the manufacturer based implants, in the absence of implant rupture. Thus, and were replaced with saline-based implants. On head and neck specialists should consider siliconomas removal, there was no evidence of implant rupture as a cause for cervical lymphadenopathy in patients with or leakage. She had no other relevant medical saline-based breast implants. history. She was a non-smoker and consumed five units of alcohol per week. On examination, she had multiple bilateral BACKGROUND palpable lymph nodes in levels IV and Vb, more Cervical lymphadenopathy can be caused by an prominent on the left. A flexible nasoendoscopy array of different pathologies. These can be catego- and oral cavity examination were unremarkable. rised into either benign (eg, systemic lupus erythe- At this stage, the differential diagnosis included matosus, Epstein- Barr virus, toxoplasmosis) or lymphoma, head and neck cancer, metastases and malignant (eg, lymphoma, metastatic disease).1 A reactive lymphadenopathy secondary to infection. comprehensive history and examination is essential http://casereports.bmj.com/ in elucidating the most likely diagnoses. Addition- INVESTIGATIONS ally, in high- risk patients, it is crucial to undertake The patient subsequently underwent various blood appropriate investigations to rule out more sinister tests including a Toxoplasma gondii and Cytomeg- pathology such as head and neck cancers. alovirus screen. These were conducted since these Breast implants are frequently used in both two opportunistic infections often have mild clin- aesthetic and reconstructive breast surgery. They ical courses and are associated with generalised are composed of silicone shells filled with saline or silicone gel.2 Numerous studies have examined the safety of such implants and demonstrated the potential for ruptures, malignancies and inflamma- on September 29, 2021 by guest. Protected copyright. tory reactions.3 4 Silicone-associated lymphadenop- athy occurs following migration of silicone particles to regional lymph nodes. This can be a consequence of implant rupture, or when microscopic amounts of silicone gel leak from the outer shell (known as ‘gel bleed’). The majority of cases result in axillary or mediastinal lymphadenopathy. There are very few reported cases of silicone associated cervical lymphadenopathy.5 6 This case report both adds to the limited litera- © BMJ Publishing Group Limited 2021. Re- use ture and emphasises the importance of considering permitted under CC BY- NC. No silicone granulomas as a potential cause for cervical commercial re-use . See rights lymphadenopathy in patients with saline- based and permissions. Published breast implants. Figure 1 Ultrasonography of affected lymph nodes by BMJ. demonstrating the snowstorm sign ultrasonography demonstrating multiple enlarged lymph nodes with a To cite: Rajgor AD, Mentias Y, Stafford F. BMJ CASE PRESENTATION heterogeneous echogenic pattern and dispersion of the Case Rep 2021;14:e239395. A- 54- year old woman presented to the outpatient ultrasound beam causing posterior acoustic shadowing doi:10.1136/bcr-2020- ear, nose and throat neck lump clinic with a 2-week (snowstorm sign). Features indicative of a silicone 239395 history of multiple bilateral neck lumps. These granuloma. Rajgor AD, et al. BMJ Case Rep 2021;14:e239395. doi:10.1136/bcr-2020-239395 1 Case report BMJ Case Rep: first published as 10.1136/bcr-2020-239395 on 3 March 2021. Downloaded from With regard to the enlarged lymph nodes, the dilemma lies in whether to opt for excision or monitor. This is a decision that should be made alongside the patient highlighting the benefits and risks of removal. In this case, as the lymphadenopathy was not causing any issues (eg, compressive symptoms, recurrent lymphadenitis/infections) no further treatment from the otolar- yngologist was required. Figure 2 Photomicrograph of the silicone granuloma (A) Overall this case report demonstrates a rare presentation of Photomicrograph (magnification ×30, H&E stain) demonstrating cervical lymphadenopathy caused by silicone gel bleeding from numerous empty vacuoles and multinucleate giant cells. The empty saline- based breast implants. This is an entity all healthcare vacuoles previously contained silicone, which has been dissolved during professionals should consider when patients with breast implants preparation of the specimen. (B) Photomicrograph (magnification ×30) present with regional lymphadenopathy. confirms the specimen is CD68 positive, a marker of macrophages. Learning points 7 lymphadenopathy. Both these screens were negative for an ► Otolaryngologists should remember the importance of acute infection. bleeding gel from the silicone shell of saline- based breast The crucial investigation in this case was an ultrasonography implants as a cause of cervical lymphadenopathy. guided biopsy of the lymph node. The ultrasonography (figure 1) ► If a silicone granuloma in the neck is identified, consider demonstrated multiple mildly enlarged lymph nodes in levels IV imaging of the breast implant to ensure integrity. and Vb bilaterally with the largest measuring up to 1.5 cm. There ► The importance of taking a comprehensive history to identify was a heterogeneous echogenic pattern with dispersion of the the differential diagnoses. ultrasound beam causing posterior acoustic shadowing (snow- storm sign). A CT scan of the neck also confirmed the presence of bilateral small volume lymphadenopathy. Contributors ADR was involved in the creation and revision of the manuscript and acquisition of all figures and consent from the patient.YM was involved in the The core biopsy (figure 2) revealed lymph node tissue with revision of the manuscript and interpretation of the radiological images. FS was macrophages containing large vacuoles, scattered lymphocytes involved in the creation and revision of the manuscript and was the designated and multinucleate giant cells. These findings were typical of a otolaryngology consultant in this case. silicone granuloma and the silicone had most likely dissolved Funding This study was funded by National Institute for Health Research (NIHR) UK from the vacuoles while preparing the specimen. (ACF-2018-01-007). Competing interests None declared. OUTCOME AND FOLLOW-UP Patient consent for publication Obtained. Following discussion at the multidisciplinary team meeting Provenance and peer review Not commissioned; externally peer reviewed. (including the plastic surgery team), it was concluded that Open access This is an open access article distributed in accordance with the http://casereports.bmj.com/ given saline-based implants are covered in a silicone shell, the Creative Commons Attribution Non Commercial (CC BY- NC 4.0) license, which lymphadenopathy was likely a consequence of gel bleeding. permits others to distribute, remix, adapt, build upon this work non- commercially, and license their derivative works on different terms, provided the original work Subsequently, no further treatment was required. She currently is properly cited and the use is non- commercial. See: http:// creativecommons. org/ remains well and has been reassured that this is not a malignant licenses/ by- nc/ 4. 0/. cause. ORCID iD Amarkumar Dhirajlal Rajgor http:// orcid. org/ 0000- 0002- 9323- 3107 DISCUSSION Silicone- associated lymphadenopathy occurs following the depo- REFERENCES sition of silicone in lymph nodes. Silicone can enter surrounding 1 Bromber ME. Assessment of lymphadenopathy. BMJ Best Practice 2020 https:// on September 29, 2021 by guest. Protected copyright. tissue following frank rupture of the implant or a ‘gel bleed’ from bestpractice. bmj. com/ best- practice/ monograph/ 1179. html 8 9 the outer silicone shell. These exposed silicone particles can 2 Bauer PR, Krajicek BJ, Daniels CE, et al. Silicone breast implant- induced subsequently migrate to regional lymph nodes
Recommended publications
  • Left Supraclavicular Lymphadenopathy As the Only Clinical Presentation of Prostate Cancer: a Case Report
    ACTA MEDICA MARTINIANA 2017 17/2 DOI: 10.1515/acm-2017-0011 41 LEFT SUPRACLAVICULAR LYMPHADENOPATHY AS THE ONLY CLINICAL PRESENTATION OF PROSTATE CANCER: A CASE REPORT MOHANAD ABUSULTAN1, HANZEL P2, DURCANSKY D3, HAJTMAN A3. 1Department of Otorhinolaryngology, Prievidza Hospital, Slovak Republic 2Comenius University, Jessenius Faculty of Medicine and University Hospital in Martin, Clinic of Otorhinolaryngology, Head and Neck Surgery, Martin, Slovak Republic 3Department of Pathology, Prievidza Hospital, Slovak Republic A bstract Prostate cancer usually metastasis to the regional lymph nodes and can rarely metastases to nonregional supradi- aphragmatic lymph nodes. Cervical lymph node metastasis of prostate cancer is extremely rare. However, it should be considered in the differential diagnosis of cervical lymphadenopathy in male patients with adenocarcinoma of unknown primary site. In this report we present a rare case of metastatic prostate adenocarcinoma with left supra- clavicular lymphadenopathy as the only clinical presentation with no other evidence of metastasis to the regional lymph nodes or bone metastasis. Key words: Prostate cancer, Supraclavicular lymphadenopathy, Metastasis INTRODUCTION Most of cancer metastasis to the cervical lymph nodes is from cancers of the mucosal surfaces of the upper aerodigestive tract. The second most common source of metastasis is nonmucosal tumors in the head and neck such as salivary glands, thyroid glands and skin [1]. Cancers originating from sites other than the head and neck can rarely metastasize to the cervical lymph nodes. However, neoplasms of the genitourinary tract make up a sig- nificant proportion of these cancers and should be considered in the differential diagnosis of neoplastic lesions of the head and neck [2].
    [Show full text]
  • M. H. RATZLAFF: the Superficial Lymphatic System of the Cat 151
    M. H. RATZLAFF: The Superficial Lymphatic System of the Cat 151 Summary Four examples of severe chylous lymph effusions into serous cavities are reported. In each case there was an associated lymphocytopenia. This resembled and confirmed the findings noted in experimental lymph drainage from cannulated thoracic ducts in which the subject invariably devdops lymphocytopenia as the lymph is permitted to drain. Each of these patients had com­ munications between the lymph structures and the serous cavities. In two instances actual leakage of the lymphography contrrult material was demonstrated. The performance of repeated thoracenteses and paracenteses in the presenc~ of communications between the lymph structures and serous cavities added to the effect of converting the. situation to one similar to thoracic duct drainage .The progressive immaturity of the lymphocytes which was noted in two patients lead to the problem of differentiating them from malignant cells. The explanation lay in the known progressive immaturity of lymphocytes which appear when lymph drainage persists. Thankful acknowledgement is made for permission to study patients from the services of Drs. H. J. Carroll, ]. Croco, and H. Sporn. The graphs were prepared in the Department of Medical Illustration and Photography, Dowristate Medical Center, Mr. Saturnino Viloapaz, illustrator. References I Beebe, D. S., C. A. Hubay, L. Persky: Thoracic duct 4 Iverson, ]. G.: Phytohemagglutinin rcspon•e of re­ urctcral shunt: A method for dccrcasingi circulating circulating and nonrecirculating rat lymphocytes. Exp. lymphocytes. Surg. Forum 18 (1967), 541-543 Cell Res. 56 (1969), 219-223 2 Gesner, B. M., J. L. Gowans: The output of lympho­ 5 Tilney, N.
    [Show full text]
  • The Size of Lymph Nodes in the Neck on Sonograms As a Radiologic Criterion for Metastasis: How Reliable Is It?
    AJNR Am J Neuroradiol 19:695–700, April 1998 The Size of Lymph Nodes in the Neck on Sonograms as a Radiologic Criterion for Metastasis: How Reliable Is It? Michiel W. M. van den Brekel, Jonas A. Castelijns, and Gordon B. Snow PURPOSE: A definition of cut-off points for nodal size is essential to determine whether cervical lymph nodes are metastatic or not. Because the currently used size criteria are defined for random populations of patients with head and neck cancer, we set out to study whether these criteria are optimal for patients without palpable metastases in different levels of the neck. We defined optimal size criteria for sonography by calculating the sensitivity and specificity of different size cut-off points. METHODS: We compared the sensitivity and specificity of different size cut-off points as measured on sonograms for various levels in the neck in a series of 117 patients with and 131 patients without palpable neck metastases. RESULTS: A minimum axial diameter of 7 mm for level II and 6 mm for the rest of the neck revealed the optimal compromise between sensitivity and specificity in necks without palpable metastases. For all necks together (with and without palpable metastases), the criteria were 1 to 2 mm larger. CONCLUSION: Our findings indicate that the current sonographic size criteria used for random patient populations are not optimal for necks without palpable metastases, nor can the same cut-off points be used for all levels in the neck. The management of lymph node metastases in the cious lymph nodes may convert both selective neck neck in patients with squamous cell carcinoma of the treatment and a wait-and-see policy to more secure upper air and food passages is a continuing source of comprehensive treatment of all levels of the neck (6).
    [Show full text]
  • Ultrasonographic Evaluation of Cervical Lymph Nodes in Kawasaki Disease
    Ultrasonographic Evaluation of Cervical Lymph Nodes in Kawasaki Disease Norimichi Tashiro, MD; Tomoyo Matsubara, MD; Masashi Uchida, MD; Kumiko Katayama, MD; Takashi Ichiyama, MD; and Susumu Furukawa, MD ABSTRACT. Objective. Kawasaki disease (KD) is one tery lesions (CAL), which can lead to myocardial of the common causes of cervical lymphadenopathy dur- infarction or even death.2 Early diagnosis and treat- ing early childhood. The purpose of this study was to ment with intravenous gammaglobulin (IVGG) can compare the ultrasonographic feature of cervical lymph reduce the risk of cardiac complications of KD.3 Be- nodes in patients with KD, bacterial lymphadenitis, and cause there are no specific diagnostic tests for KD, infectious mononucleosis. Design. We studied 22 patients with KD, 8 with pre- the diagnosis is established by the presence of 5 of 6 sumed bacterial lymphadenitis, and 5 with Epstein-Barr criteria in the absence of some other explanation for virus infectious mononucleosis. We examined the cervi- the illness.1 The Japanese diagnostic criteria include cal nodes by ultrasonography using a 7.5-MHz or 10- the following: 1) fever persisting for 5 days or longer; MHz transducer of a B-mode sector scanner in all pa- 2) nonexudative conjunctival injections; 3) oral mu- tients with a chief complaint of fever and a visible cosal changes; 4) changes of the peripheral extremi- cervical mass during a fixed time interval (July 1995- ties; 5) rash, primarily truncal; and 6) cervical lymph- March 2000). adenopathy (at least 15 mm in diameter). Cervical Results. In KD patients, transverse ultrasonograms demonstrated multiple hypoechoic-enlarged nodes form- lymphadenopathy is the least common diagnostic ing one palpable mass, which resembled a cluster of criterion and is present in approximately 50% to 75% grapes.
    [Show full text]
  • Patterns of Lymphatic Drainage in the Adultlaboratory
    J. Anat. (1971), 109, 3, pp. 369-383 369 With 11 figures Printed in Great Britain Patterns of lymphatic drainage in the adult laboratory rat NICHOLAS L. TILNEY Department of Surgery, Peter Bent Brigham Hospital, and Harvard Medical School, Boston, Massachusetts (Accepted 27 April 1971) INTRODUCTION This study was undertaken to define and elucidate patterns of lymphatic drainage in the adult laboratory rat. The incentive for the work arose from investigations into the role of regional lymphatics in the sensitization of the host by skin allografts. It has become clear that the response of rats to antigens, investigated increasingly in the available inbred strains, requires an accurate knowledge of lymphoid anatomy and lymphatic drainage routes. Examinations of the lymphatics of specific body areas of the rat have appeared sporadically in the literature, but descriptions of regional drainage patterns, especially of peripheral sites, are unavailable. Previous investigations by Job (1919), Greene (1935) and Sanders & Florey (1940) have con- centrated primarily upon the location of the lymphoid tissues. Miotti (1965) has stressed visceral drainage, and Higgins (1925) has described the lymphatic system of the newborn rat. A more complete definition of both somatic and visceral lymphatic routes is presented. MATERIALS AND METHODS One hundred and thirty normal adult rats of both sexes, each weighing between 150 and 300 g, were studied. The animals came from five strains: each inbred - Oxford strains of the albino (AO), hooded (HO), agouti (DA), and F1 hybrid of the HO and DA strains - and 'stock' animals from a closed outbred albino colony. Under ether anaesthesia, the site for cutaneous injection was clipped or a serous cavity entered for visceral injection.
    [Show full text]
  • An Approach to Cervical Lymphadenopathy in Children
    Singapore Med J 2020; 61(11): 569-577 Practice Integration & Lifelong Learning https://doi.org/10.11622/smedj.2020151 CMEARTICLE An approach to cervical lymphadenopathy in children Serena Su Ying Chang1, MMed, MRCPCH, Mengfei Xiong2, MBBS, Choon How How3,4, MMed, FCFP, Dawn Meijuan Lee1, MBBS, MRCPCH Mrs Tan took her daughter Emma, a well-thrived three-year-old girl, to the family clinic for two days of fever, sore throat and rhinorrhoea. Apart from slight decreased appetite, Mrs Tan reported that Emma’s activity level and behaviour were not affected. During the examination, Emma was interactive, her nose was congested with clear rhinorrhoea, and there was pharyngeal injection without exudates. You discovered bilateral non-tender, mobile cervical lymph nodes that were up to 1.5 cm in size. Mrs Tan was uncertain if they were present prior to her current illness. There was no organomegaly or other lymphadenopathy. You treated Emma for viral respiratory tract illness and made plans to review her in two weeks for her cervical lymphadenopathy. WHAT IS LYMPHADENOPATHY? masses in children can be classified into congenital or acquired Lymphadenopathy is defined as the presence of one or more causes. Congenital lesions are usually painless and may be identified lymph nodes of more than 1 cm in diameter, with or without an at or shortly after birth. They may also present with chronic drainage abnormality in character.(1) In children, it represents the majority or recurrent episodes of swelling, which may only be obvious in later of causes of neck masses, which are abnormal palpable lumps life or after a secondary infection.
    [Show full text]
  • Intraoperative Pathological Investigation of Recurrent Nerve
    1061-1066 6/10/06 16:26 Page 1061 ONCOLOGY REPORTS 16: 1061-1066, 2006 Intraoperative pathological investigation of recurrent nerve nodal metastasis can guide the decision whether to perform cervical lymph node dissection in thoracic esophageal cancer YUJI UEDA1, ATSUSHI SHIOZAKI1, HIROSUMI ITOI2, KAZUMA OKAMOTO1, HITOSHI FUJIWARA1, DAISUKE ICHIKAWA1, SHOJIRO KIKUCHI1, NOBUAKI FUJI1, TSUYOSHI ITOH1, TOSHIYA OCHIAI1, SHUHEI KOMATSU1 and HISAKAZU YAMAGISHI1 1Department of Surgery, Division of Digestive Surgery, Kyoto Prefectural University of Medicine Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566; 2Department of Surgery, Meiji University of Oriental Medicine Graduate School of Acupuncture and Moxibustion, Hiyoshi-cho, Nantan, Kyoto 602-0392, Japan Received July 3, 2006; Accepted August 7, 2006 Abstract. Three-field lymph node dissection has been widely evidence of cervical lymph node metastasis. The remaining used to treat thoracic esophageal cancer, but is very invasive 31 patients had no recurrent nerve nodal metastasis on and can cause serious complications. Whether cervical lymph intraoperative pathological examination and therefore did node dissection should be performed in all patients with not receive cervical lymph node dissection. None of these thoracic esophageal cancer remains controversial. We patho- patients had cervical lymph node recurrence on follow-up. logically examined the recurrent nerve lymph nodes during We compared patients who underwent intraoperative patho- surgery in patients with thoracic esophageal cancer to determine logical investigation with those who underwent conventional the presence or absence of lymph node involvement. In patients 3-field lymph node dissection (without performing intra- without recurrent nerve nodal involvement, cervical lymph operative pathological investigation).
    [Show full text]
  • Level VI Lymph Nodes: an Anatomic Study of Lymph Nodes Located Between the Recurrent Laryngeal Nerve and the Right Common Carotid Artery
    DOI: 10.1590/0100-6991e-20181972 Artigo Original Linfonodos do nível VI: estudo anatômico dos linfonodos localizados entre o nervo laríngeo recorrente e a artéria carótida comum direita. Level VI lymph nodes: an anatomic study of lymph nodes located between the recurrent laryngeal nerve and the right common carotid artery. SAMIR OMAR SALEH1; FLÁVIO CARNEIRO HOJAIJ1; ANA MARIA ITEZEROTI1; CRISTINA PIRES CAMARGO1; KASSEM SAMIR SALEH2; MAURO FIGUEIREDO CARVALHO DE ANDRADE1; FLÁVIA EMI AKAMATSU1; ALFREDO LUIZ JACOMO1 RESUMO Objetivo: descrever a presença de linfonodos e suas relações com características demográficas e antropométricas em uma região específica ainda não descrita pelos compêndios de anatomia, por nós denominada de Recesso Carotídeo Recorrencial (RCR), localizada entre o nervo laríngeo recorrente direito, a artéria carótida comum direita e a artéria tireoidea inferior direita. Métodos: foram dissecadas 32 regiões cervicais à direita de cadáveres com até 24 horas de post mortem. O tecido fibrogorduroso do RCR foi ressecado e preparado com fixação em formol. Em seguida, foi submetido a uma sequência crescente de álcoois (70%, 80% e 90%), posteriormente a uma solução de Xilol e, por fim, a uma solução de Salicilato de Metila, respeitando o tempo necessário de cada etapa. O estudo macroscópico foi realizado na peça diafanizada, observando a presença ou não de linfonodos. Quando presentes, foram fotografados e suas medidas foram aferidas com um paquímetro digital. No estudo microscópico, foi utilizada a coloração hematoxilina-eosina para confirmação do linfonodo. Resultados: observou-se a presença de linfonodos em 22 dos 32 espécimes (68,75%), com o número de linfonodos por cadáver variando de zero a seis (média de 1,56±0,29) e tamanho com média de 7,82mmx3,86mm (diâmetros longitudinal x transversal).
    [Show full text]
  • Supraclavicular Lymphadenitis Following COVID-19
    Supraclavicular Lymphadenitis Following COVID-19 Raid M. Al-Ani ( [email protected] ) University Of Anbar, College of Medicine, Department of Surgery/Otolaryngology https://orcid.org/0000-0003-4263-9630 Rasheed Ali Rashid Tikrit University, College of Medicine, Department of Surgery/Otolaryngology Case Report Keywords: COVID-19, Supraclavicular lymph node, cervical lymphadenopathy Posted Date: July 6th, 2021 DOI: https://doi.org/10.21203/rs.3.rs-670161/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/9 Abstract Introduction Cervical lymphadenopathy in children is a common problem in daily clinical practice. Many cases of cervical lymphadenopathy after the COVID-19 vaccine were reported. However, there is no yet reporting a case of supraclavicular cervical lymphadenopathy as a result of COVID-19. Case presentation A 12-years-old girl presented with fever, cough, fatigue, anosmia, and ageusia. COVID-19 was conrmed by real-time PCR. The symptoms were resolved within 10 days. After 7 days, she complained of supraclavicular swelling. Physical examination revealed painless, multiple, and mobile supraclavicular lymph nodes. Ultrasound and ne-needle aspiration cytology were suspicious. Therefore, an excisional biopsy of the largest node was performed. The specimen was sent for histopathology and immunohistochemistry evaluation which conrmed the benign nature of the lymph node. Conclusion To our best knowledge, this is the rst case of supraclavicular lymphadenopathy in a child with COVID- 19. It is essential to put COVID-19 in the differential diagnosis of cervical lymphadenopathy. Introduction There are various otorhinolaryngological manifestations as a result of the COVID-19 pandemic, including, but not limited to, smell and taste abnormalities, dysphonia, hearing loss, sore throat, nasal obstruction, and parotitis [1][2][3].
    [Show full text]
  • Ultrasonographic Evaluation of Cervical Lymph Nodes in Kawasaki Disease
    Ultrasonographic Evaluation of Cervical Lymph Nodes in Kawasaki Disease Norimichi Tashiro, MD; Tomoyo Matsubara, MD; Masashi Uchida, MD; Kumiko Katayama, MD; Takashi Ichiyama, MD; and Susumu Furukawa, MD ABSTRACT. Objective. Kawasaki disease (KD) is one tery lesions (CAL), which can lead to myocardial of the common causes of cervical lymphadenopathy dur- infarction or even death.2 Early diagnosis and treat- ing early childhood. The purpose of this study was to ment with intravenous gammaglobulin (IVGG) can compare the ultrasonographic feature of cervical lymph reduce the risk of cardiac complications of KD.3 Be- nodes in patients with KD, bacterial lymphadenitis, and cause there are no specific diagnostic tests for KD, infectious mononucleosis. Design. We studied 22 patients with KD, 8 with pre- the diagnosis is established by the presence of 5 of 6 sumed bacterial lymphadenitis, and 5 with Epstein-Barr criteria in the absence of some other explanation for virus infectious mononucleosis. We examined the cervi- the illness.1 The Japanese diagnostic criteria include cal nodes by ultrasonography using a 7.5-MHz or 10- the following: 1) fever persisting for 5 days or longer; MHz transducer of a B-mode sector scanner in all pa- 2) nonexudative conjunctival injections; 3) oral mu- tients with a chief complaint of fever and a visible cosal changes; 4) changes of the peripheral extremi- cervical mass during a fixed time interval (July 1995- ties; 5) rash, primarily truncal; and 6) cervical lymph- March 2000). adenopathy (at least 15 mm in diameter). Cervical Results. In KD patients, transverse ultrasonograms demonstrated multiple hypoechoic-enlarged nodes form- lymphadenopathy is the least common diagnostic ing one palpable mass, which resembled a cluster of criterion and is present in approximately 50% to 75% grapes.
    [Show full text]
  • Lymphadenopathy After the Anti-COVID-19 Vaccine: Multiparametric Ultrasound Findings
    biology Article Lymphadenopathy after the Anti-COVID-19 Vaccine: Multiparametric Ultrasound Findings Giulio Cocco 1,* , Andrea Delli Pizzi 2, Stefano Fabiani 1 , Nino Cocco 3, Andrea Boccatonda 4 , Alessio Frisone 5, Antonio Scarano 5 and Cosima Schiavone 1 1 Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, “G. d’Annunzio” University, 66100 Chieti, Italy; [email protected] (S.F.); [email protected] (C.S.) 2 Department of Neurosciences, Imaging and Clinical Sciences, “G. d’Annunzio” University, 66100 Chieti, Italy; [email protected] 3 Departmental Faculty of Medicine and Surgery, Campus Bio-Medico University, 00128 Rome, Italy; [email protected] 4 Department of Internal Medicine, University of Bologna, 40010 Bologna, Italy; [email protected] 5 Department of Innovative Technologies in Medicine & Dentistry, “G. d’Annunzio” University, 66100 Chieti, Italy; [email protected] (A.F.); [email protected] (A.S.) * Correspondence: [email protected] Simple Summary: Post-anti-COVID-19 vaccine lymphadenopathy is a not uncommon event. In this study, we investigated the multiparametric ultrasound findings of patients with post-vaccine lym- phadenopathy and compared these findings among different anti-COVID-19 vaccines. We evaluated patients presenting with post-anti-COVID-19 lymphadenopathy. The presence, size, location, number, morphology, cortex–hilum, superb microvascular imaging and elastosonography of lymph nodes were assessed. They were axillary and supraclavicular ipsilateral to the injection site. Prevalent Citation: Cocco, G.; Delli Pizzi, A.; ultrasound features included oval morphology, asymmetric cortex with hilum evidence, central and Fabiani, S.; Cocco, N.; Boccatonda, A.; peripheral vascular signals at superb microvascular imaging and elastosonography patterns similar Frisone, A.; Scarano, A.; Schiavone, to the surrounding tissue.
    [Show full text]
  • An Asymptomatic Submandibular Mass : a Clinicopathologic Conference
    Review Article ISSN: 2574 -1241 DOI: 10.26717/BJSTR.2019.21.003540 An Asymptomatic Submandibular Mass : A Clinicopathologic Conference Priyanka Singh1, Pavan M Patil2*, Seema P Patil3 and Mithilesh Mishra4 1Post Graduate Student, Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Sharda University, India 2Professor and Head of Department, Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Sharda University, India 3Director, COSMOZONE Dental and Implant Clinic, India 4Associate Professor, Department of Oral Pathology and Microbiology, School of Dental Sciences, Sharda University, India *Corresponding author: Pavan M Patil, Professor and Head of Department, Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Sharda University, India ARTICLE INFO Abstract Received: August 26, 2019 We present a rare case of isolated submandibular lymph node sarcoidosis with no Published: August 30, 2019 systemic involvement. Differential diagnosis of cervical swellings is discussed. This sarcoidosis. Long term follow up is recommended in such cases as these manifestations Citation: Priyanka S, Pavan M P, Seema P maycase servehighlights as precursors the diagnostic for systemic difficulties sarcoidosis. in isolated head and neck manifestations of P, Mithilesh M. An Asymptomatic Subm- andibular Mass : A Clinicopathologic Con- Keywords: Sarcoidosis; Submandibular Swelling; Lymph Node; Neck Swelling ference. Biomed J Sci & Tech Res 21(1)- 2019. BJSTR. MS.ID.003540. Clinical Presentation actual dimension. The left submandibular salivary gland was A 53-year-old male patient complained of a swelling in the left neck lasting 6 months. The growth was painless and asymptomatic Intra oral examination and dental health were unremarkable. His except for the slight discomfort to the patient due to the growth.
    [Show full text]