Emergency room imaging findings in patients presenting after COVID-19 vaccination

Objectives: Data on potential side effects of COVID-19 vaccines remains limited. This study aims to evaluate the relationship between the clinical presentations and imaging findings of emergency room (ER) patients presenting with suspected side effects or complications of recent COVID-19 vaccination.

Materials and methods: An Institutional Review Board-approved retrospective analysis of vaccinated patients who underwent imaging studies in the ER between December 2020 and August 2021 was conducted. Reports were analyzed for imaging modality, chief complaints, and imaging findings.

Results: A total of 173 studies on 161 patients were included: 73 X-rays, 57 computed tomographys, 12 magnetic resonance imagings, and 31 ultrasounds. Analysis of the 168 reports dictated in these 173 studies revealed chest pain (27%), shortness of breath (17%), headache (12.5%), fever (10%), and cough (11.9%) as the most common presenting signs/symptoms. About 57.7% of reports showed no post-vaccine complications. Of the 42.3% of reports with findings, lung opacities/consolidation (36.6%) and cervical and/or axillary adenopathy (35.2%) were most commonly seen; other major findings included saddle embolus (1.4%) and vertebral artery occlusion (1.4%).

Conclusion: Chest pain, cough, shortness of breath, and headache were the most common presenting symptoms in the ER after COVID-19 vaccination, and chest X-ray and computed tomography chest angiography were the most commonly ordered studies to assess vaccine-related complications. Lung opacities/consolidations were the most common findings. Given that vascular post-vaccine complications are considered the most dangerous and 2.8% of reports demonstrated positive vascular findings, concern for vascular complications should initiate appropriate imaging to ensure prompt diagnosis and management.