Shoulder Injury Related to Vaccine Administration (SIRVA)

Brandon C. Taylor, MD; David Hinke, MD

Disclosures

Appl Radiol. 2014;43(12):30-31. 

In This Article

Imaging Findings

Initial non-enhanced MRI of the left shoulder demonstrated abnormal osseous edema in the lateral humeral head and neck, and abnormal soft tissue edema in the teres minor muscle, including its myotendinous junction and humeral insertion (Figures 1 and 2). These post-injection findings were attributed to sequela from direct needle impact and reactive change related to the injected material. A 3-month follow-up (after an ineffective subacromial corticosteroid injection) non-enhanced MRI demonstrated ongoing inflammatory disease as evidenced by new visualization of an 8-mm humeral head cortical erosion (Figure 3).

Figure 1.

A single T2-weighted axial fat-suppressed non-enhanced MR image of the left shoulder demonstrates abnormal T2 hyperintensity, indicative of edema, within the greater tuberosity of the humeral head. In addition, edema is visualized in the teres minor muscle, including the distal tendon fibers at the level of the humeral insertion.

Figure 2.

A single T2-weighted, coronal, fat-suppressed, non-enhanced MR image of the left shoulder demonstrates edema within the teres minor at the myotendinous junction and within the distal tendons at the humeral insertion.

Figure 3.

A 3-month follow-up T2-weighted, single axial, fat-suppressed, non-enhanced MR image of the left shoulder demonstrates an 8-mm humeral head cortical erosion (red arrow). There is minimal improvement of the previously seen osseous and tendinous edema. These findings are indicative of an ongoing inflammatory process.

The patient's pain persists, but at approximately 6 weeks post-injection, her pain with sleep reduced from 4/10 to 2/10. In addition, her rest pain reduced from 5/10 to 3/10 at approximately 7 weeks but with persistent mild restricted motion on physical exam.

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