Throughout this recent ongoing SARS-CoV-2 pandemic, the European Society of Breast Imaging have surely contributed in improving the management of unilateral axillary adenopathy appearance homolaterally to the side of vaccine inoculation. After considering the patient’s COVID-19 history of vaccination, our group produced a day-to-day scheme that evaluates meticulously the probability of mammary malignancy, according to the lymph node characteristics including vascular abnormalities. It comprises of a UN (ultrasound node) score ranging from 2 to 5, that increases with the suspicion of malignancy. In this setting and in view of the additional incoming COVID-19 boost-dose vaccinations, we believe our model could be of great utility to radiologist when assessing patients whom do not have a straight forward diagnosis, in order to reduce breast cancer missed diagnosis, avoid delaying vaccinations, reduce rescheduling of breast imaging examinations and lastly avoid unnecessary lymph node biopsies.

Modic type 1 changes on MRI are increasingly recognized as a source of chronic low back pain (cLBP), often resistant to conventional therapies. Oxygen-ozone (O2-O3) therapy (OOT) has emerged as a minimally invasive treatment option due to its analgesic, anti-inflammatory, and immunomodulatory properties. A 68-year-old woman presented with bilateral cLBP and right leg pain, exacerbated in the morning and after inactivity, associated with Modic 1 changes at the L5-S1 level. Previous treatments with analgesics, steroids, and physical therapy were ineffective. From May 2024, the patient received weekly bilateral paravertebral intramuscular O2-O3 injections (10 mL per side, 10 μg/mL) and rectal O2-O3 insufflation (25 μg/mL, 150 mL/session) for twelve weeks. Significant symptom improvement was noted by the fourth session, with complete resolution by the tenth. Analgesic medications were discontinued after the fourth session. MRI at six months post-treatment showed complete resolution of inflammatory edema and restoration of bone trabeculae, with persistent Modic 2 changes and resorption of a median disc protrusion at L4-L5. This integrated OOT approach (paravertebral intramuscular injections plus rectal insufflation) may represent a promising conservative option in selected patients, but these findings are preliminary and require confirmation in controlled studies before any treatment recommendations can be made.