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In this pictorial essay, we illustrate the ultrasound appearance of COVID-19 Pfizer-BioNTech vaccine-related lymph node abnormalities, which can occur at different stations ipsilateral to the site of vaccination, after either first or second vaccine dose and can represent a diagnostic dilemma when encountered in patients with underlying conditions. Typically, they appear as enlarged hypoechoic nodes with loss of fat hilum, increased hilar and cortical vascularization at color-Doppler, but low to intermediate cortical consistence at shear-wave elastography. Asymmetric or diffuse cortical thickening is also frequently encountered. They can be observed in patients without and with clinical symptoms, such as armpit pain, fever and fatigue.

Ultrasound and shear-wave elastography patterns of COVID-19 mRNA vaccine-related axillary, supra and subclavicular lymphadenopathy