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CASE REPORT
Year : 2021  |  Volume : 29  |  Issue : 2  |  Page : 129-131

The evaluation of palpable thigh nodularity in vaccination-age children – Differentiating vaccination granulomas from other causes


Our Lady's Children's Hospital, Crumlin, Dublin, Ireland

Correspondence Address:
Dr Douglas Mulholland
Our Lady's Children's Hospital, Crumlin, Dublin
Ireland
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JMU.JMU_51_20

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Palpable thigh nodularity is a relatively frequent indication for imaging of vaccination-age children, with patients often referred by their community physician or general practitioner. Ultrasound (US) is the imaging modality of choice to delineate the abnormality, and we present a number of characteristic findings that permit the radiologist and pediatrician to accurately identify the cause. A retrospective review was performed at the largest children's hospital in a European country between 2015 and 2017 over a 30-month period. A search was performed of the hospital's Picture Archiving and Communication System (PACS) for all children referred for a soft-tissue, upper limb, or lower limb US between January 2015 and July 2017. The findings were collated and stored in a spreadsheet. Nine patients were identified who developed subcutaneous nodules in the thigh at some point during their childhood vaccination schedule. Three of these patients had clinical histories strongly suggestive of a diagnosis of abscess or foreign body. The remaining six patients were selected for more in-depth analysis. Four of these patients had US features consistent with vaccination granuloma. Two patients were ultimately diagnosed with venolymphatic malformations. Palpable thigh nodularity in a child of vaccination age is encountered with a reasonable frequency. When encountered, granulomas tend to be located within the subcutaneous tissues, and we postulate that this is due to erroneous administration of a vaccine into the subcutis rather than into the muscle.


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