0:01

So this was a interesting case.

0:03

And so this was a patient that had a history of melanoma and had,

0:08

um, a palpable mass involving the right per area. And,

0:13

and this was a a a a A mass. Right here you can see the abnormal enhancement.

0:19

So I think you can probably see it here.

0:21

While that's loading on the axial images,

0:24

we see some uptake right here involving the left neck. Oh, good.

0:27

Here are the sagal that loaded.

0:31

So when we look here in the left side,

0:35

we can see all of these lymph nodes on the left side. So the question was,

0:40

patient has a history of melanoma.

0:44

This mass involving the right neck was biopsied and it came back recurrent

0:48

melanoma.

0:51

But then on the left hand side we see all of these abnormally enhancing lymph

0:55

nodes. So the issue is what is this?

0:59

So was there any specific history that you would ask for,

1:03

especially now in 2000 and at this time it was about a year in 2021,

1:07

you can see.

1:08

Was there any specific history that you should ask the patient for to help

1:12

determine whether these are actually metastatic melanoma lymph nodes or it could

1:17

be something else.

1:19

Covid 19

1:20

Ation. Exactly. So at, at that time we didn't know about it. I,

1:25

I had just seen a, an article on Covid 19 vaccinations.

1:29

So when I saw this I was like, you know, they were worried about melanoma.

1:33

I said, you know, ask the patient,

1:35

they had the covid vaccine and they did have a left-sided covid vaccine.

1:39

So the surgeons went ahead and, uh,

1:42

biopsied and extracted this left axillary lymph node and it came back reactive.

1:47

So this actually was a reactive lymph node, did not contain any melanoma.

1:51

So this was a patient that had a melanoma met to the right side of the neck,

1:54

but on the left side of all this axillary adenopathy was due to reaction

1:59

from the COVID 19 vaccination.

2:01

So that was kind of an interesting case from an oncology standpoint because now

2:05

anytime that we are evaluating the neck to look for lymph nodes and we see

2:10

a clustering of asymmetrical lymph nodes in the axillary region,

2:15

we always have to ask the patient whether or not they've had a covid 19

2:18

vaccination because otherwise this would represent advanced stage disease.

2:23

So we don't want to confuse advanced stage disease with reaction following a

2:27

covid vaccine. Any questions on this case? You know, Ashish,

2:32

it's a good point. Um, yeah, I think in principle, yes,

2:36

the metastasis may have a higher S U V compared to the reactive lymph nodes,

2:41

but sometimes your melanoma metastasis may be smaller,

2:45

it may not have as much uptake. Similarly,

2:47

sometimes the covid vaccine may give you even a more robust response.

2:51

'cause I have examples where it's really, really bright. So for me,

2:56

um,

2:57

if I see two areas like this and I'm thinking covid vaccine,

3:02

I ne wouldn't necessarily base it on the,

3:05

I would probably base it on the location and the clumping of the lymph nodes

3:10

centered in the axillary area as opposed to just straight SS u v values.

3:13

I'm not a huge s u V fan, although I don't do nuclear medicine. I, you know,

3:17

we do see 'em in the head and neck. So I tend to,

3:20

I look at these from a different perspective. So in principle, you're correct,

3:24

tumors are gonna have higher SUVs compared to reactive lymph nodes.

3:28

But I don't think I would hang my hat purely on the ss u v values to try to

3:33

separate, in this particular case,

3:35

whether this was due to melanoma or this was due to covid vaccine.

3:39

Anytime that you see the clumping in the node,

3:41

you should always ask if they've had a.