ARRS 2022 Abstracts

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E1190. Emergency Room Imaging Findings in Patients Presenting After COVID-19 Vaccination: Preliminary Data
Authors
  1. Nadia Solomon; Yale School of Medicine
  2. Akash Patel; Yale School of Medicine
  3. Anne Sailer; Yale School of Medicine
  4. Margarita Revzin; Yale School of Medicine
Objective:
Several vaccines are being administered for COVID-19, a pandemic disease with high mortality. Because of rapid rollout, data and literature on potential vaccine side effects remain limited. This study aims to evaluate the relationship between clinical presentations and imaging findings of emergency room (ER) patients who present with symptoms suspected to be side-effects of recent COVID-19 vaccination or with imaging findings thought to be due to recent vaccination.

Materials and Methods:
This is an IRB-approved retrospective analysis of patients who underwent imaging studies in the ER between December 2020 and August 2021 to evaluate for potential vaccine complication. A search was performed for studies containing the keywords “vaccine” or “vaccination” in their reports. Studies performed to evaluate for potential vaccine complications or demonstrating imaging findings thought to be related to vaccination were included in data analysis. Studies performed on inpatient or outpatient basis were excluded from the analysis. Reports were analyzed for imaging modality, chief complaints, and imaging findings.

Results:
The search resulted in 168 reports dictated on 173 studies for 161 patients (58 men, 103 women; mean age 47 years, range 12–97 years). This included 73 x-rays, 57 CT, 12 MRI, and 31 ultrasounds. Analysis of the 168 reports revealed chest pain (27%), shortness of breath (17%), headache (12.5%), cough (11.9%), and fever (10%) to be the most common presenting signs/symptoms in the ER post vaccination. The most commonly ordered imaging studies to evaluate for complications were chest x-rays (CXR, 39.3%) and chest CTA (10.4%), in line with the most common presenting symptoms being chest pain and shortness of breath. There were 26 types of imaging studies on various body parts comprising the remaining studies ordered; 57.7% of the reports showed no post vaccine complications. Of the 42.3% reports demonstrating potential vaccine-related complications, lung opacities/consolidation (36.6%) and cervical and/or axillary adenopathy (35.2%) were the most common findings; other major findings included diverticulitis with abscess (1.4%), saddle embolus (1.4%), septic arthritis (1.4%), small bowel intussusception (1.4%), spinal cord lesion (1.4%), and vertebral artery occlusion (1.4%).

Conclusion:
Chest pain, cough, shortness of breath, and headache are the most common presenting symptoms in ER after COVID-19 vaccination. Among various available imaging modalities, CXR and chest CTA are the most commonly ordered studies in ER to assess vaccine-related complications. Lung opacities/consolidations were the most common imaging findings. Cervical/axillary lymphadenopathy, seen in 36.6% of positive studies, may represent a common side effect of vaccination. Vascular post-vaccine complications are considered the most dangerous complications. With 2.8% of reports demonstrating positive vascular findings, concern for vascular complications should initiate appropriate imaging to ensure prompt diagnosis and management.