![]() ![]() ![]() In two patients, SPECT/CT lymphoscintigraphy did not reveal any pathological findings after the disappearance of the cervical swelling, 2 and 3 weeks after the onset of the episode, respectively. In all three scans performed at the time of the acute event, tracer accumulation was visualized in the left cervical region. Single-photon-emission computed tomography (SPECT)/CT lymphoscintigraphy was performed in five patients, with three out of five scans performed during the acute episode ( Fig. All vascular structures appeared patent, there was no evidence of a thrombosis. Furthermore, we noted lymphadenopathy in all patients, mediastinal involvement in seven patients and pleural fluid in five patients. In two patients, the cervical part of the thoracic duct appeared to be wide. The larynx, thyroid gland, proximal trachea and esophagus were slightly deviated to the right in seven patients. In three patients, retropharyngeal edema extending up to level C2 was noted. The left supraclavicular (Virchows) node receives lymphatic flow from the. 1A and B), with the edema extending to the left cervical region in seven. Lymphadenopathy of the right supraclavicular node is associated with cancer in the mediastinum, lungs or esophagus. ![]() Computed tomography (CT) of the neck and chest showed edema of the supraclavicular fossa in all patients ( Fig. Ultrasound with echo-color Doppler revealed subcutaneous edema in all patients and thoracic duct dilatation in four patients. Patient 1 had a minor elevation of D-dimers and Patient 4 had long-standing anemia, which were considered not to be related to the cervical edema ( Table 2). The laboratory results did not reveal abnormalities in six patients. The clinical characteristics are summarized in Table 1. The edema extended to the left cervical region over the course of the episode in seven patients. Clinical examination revealed left-sided, non-tender and non-pitting edema of the supraclavicular fossa in all patients. The most frequently reported associated symptoms include a cervical pressure sensation, shortness of breath and general malaise. Physical activity, including jogging and gardening, and warm weather conditions were reported as eliciting factors. The mean duration of episodes in patients with symptom-free intervals was 3.8 days. Seven patients reported having multiple episodes in the past. All episodes had an acute onset of the supraclavicular fossa swelling. Five out of 8 patients were perimenopausal or menopausal at the time of diagnosis. CASE SERIESĪll patients ( n = 8) were female with a mean age of 56 (38–82) at presentation. In this case series, we report on the epidemiology, clinical presentation and imaging findings in the spontaneous cervical swelling syndrome (SCSS). Over the past few years, eight patients consulted our tertiary care facility because of a spontaneous, atraumatic swelling of the left supraclavicular fossa. The pathogenesis remains to be fully elucidated, but a transient obstruction of the thoracic duct is suspected to be the cause, which may account for the extravasation of chyle during the acute event and normalization of lymphatic transport in the in-between episodes. were the first to report on this syndrome as a distinct clinical entity. We don’t think it’s cancer but can’t tell,’ or worse, ‘We think it might be cancer.In the past, several terms have been used to refer to patients with spontaneous, atraumatic swelling of the left supraclavicular fossa, including ‘benign supraclavicular tumorous lymphangiectasia’ and ‘recurrent lymphangiectasia of the left supraclavicular fossa’. “I can’t imagine the anxiety of getting the scan and hearing, ‘We found a node that is large. Lehman, an author of two journal articles on the problem and the chief of breast imaging at the Massachusetts General Hospital. “I am particularly eager to get the word out to all the patients undergoing surveillance after successful prior treatment of cancer,” said Dr. But the enlarged lymph nodes show up as white blobs on mammograms and chest scans, resembling images that can indicate the spread of cancer from a tumor in the breast or elsewhere in the body. It can also occur after other vaccinations, including those for flu and the human papillomavirus (HPV). The swelling is a normal reaction by the immune system to the vaccine, and occurs on the same side as the arm where the shot was given. Coronavirus vaccinations can cause enlarged lymph nodes in the armpit or near the collarbone, which may be mistaken for a sign of cancer.Īs vaccines are rolled out across the country, doctors are seeing more and more of these swollen nodes in recently immunized people, and medical journals have begun publishing reports aimed at allaying fears and helping patients avoid needless testing for a harmless condition that will go away in a few weeks. ![]()
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