EURORAD ESR

Case 14117

Tonsillar syphilis mimicking carcinoma

Author(s)
S. Santos Ochoa de Eribe1, H. Portilla-Quattrociocchi2, A. Montero de la Peña2, D. Garcia Hernandez2, I. Tobalina Larrea2, A. Alvarez Alonso2.

1Hospital Universitario Araba, Radiology; Jose Atxotegi s/n 01009 Vitoria-Gasteiz, Spain;
Email:SONIA.SANTOSOCHOADEERIBE@osakidetza.eus
2Hospital Universitario Araba, Nuclear Medicine; Olaguibel 29 01009 Vitoria-Gasteiz, Spain;
 
Patient
male, 42 year(s)
 
 
  • Figure 1
    Post-contrast CT Neck
     

    Axial post-contrast neck CT demonstrating a 2.4 x2 cm isodense left tonsillar mass (arrow) with an ill-defined margin concerning for carcinoma.

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Education; Special Focus: Pathology;

    Coronal neck CT demonstrating a 2.4 x 2 cm isodense left tonsillar mass (arrows) with an ill-defined margin concerning for carcinoma.

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Education; Special Focus: Pathology;

    Axial CT of an ipsilateral cervical nodal conglomerate (dotted arrows) predominantly at level II measuring 3.6 x 2 x 4.7 cm, exerting mass effect on the internal jugular vein. The nodes have areas of central necrosis.

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Education; Special Focus: Pathology;

    Coronal view of an ipsilateral cervical nodal conglomerate (dotted arrows) predominantly at level II measuring 3.6 x 2 x 4.7 cm, exerting mass effect on the internal jugular vein. The nodes demonstrate central necrosis.

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Education; Special Focus: Pathology;
     
     
  • Figure 2
    18F-FDG PET-CT
     

    Maximum intensity projection image showed increased 18F-FDG uptake in the left tonsilar area, left cervical lymph nodes and left adrenal fossa (arrows).

     
    Area of Interest: Nuclear medicine; Imaging Technique: PET-CT; Procedure: Education; Special Focus: Pathology;

    Axial PET-CT images reveal asymmetric 18F-FDG uptake in the left tonsil (SUVmax 11.42) and left cervical nodes.

     
    Area of Interest: Lymph nodes; Imaging Technique: PET-CT; Procedure: Education; Special Focus: Pathology;
     
     
  • Figure 3
    18F-FDG PET-CT
     

    Axial PET-CT demonstrating multiple hypermetabolic foci in cervical lymphadenopathy (SUVmax of 19.07).

     
    Area of Interest: Lymph nodes; Imaging Technique: PET-CT; Procedure: Education; Special Focus: Pathology;

    PET-CT multiplanar reconstructions demonstrating multiple hypermetabolic foci in cervical lymphadenopathy (SUVmax of 19.07).

     
    Area of Interest: Lymph nodes; Imaging Technique: PET-CT; Procedure: Education; Special Focus: Pathology;
     
     
  • Figure 4
    18F-FDG PET-CT
     

    Axial PET-CT shows an heterogeneous hypermetabolic 18F-FDG focus (SUVmax 20.86) at the upper pole of the left kidney with a hypometabolic central area.

     
    Area of Interest: Adrenals; Imaging Technique: PET-CT; Procedure: Education; Special Focus: Pathology;

    The focus was consistent on coronal and sagittal fusion images with a 6.5cm left adrenal mass.

     
    Area of Interest: Adrenals; Imaging Technique: PET-CT; Procedure: Education; Special Focus: Pathology;
     
     
Axial post-contrast neck CT demonstrating a 2.4 x2 cm isodense left tonsillar mass (arrow) with an ill-defined margin concerning for carcinoma.
 
Coronal neck CT demonstrating a 2.4 x 2 cm isodense left tonsillar mass (arrows) with an ill-defined margin concerning for carcinoma.
 
Axial CT of an ipsilateral cervical nodal conglomerate (dotted arrows) predominantly at level II measuring 3.6 x 2 x 4.7 cm, exerting mass effect on the internal jugular vein. The nodes have areas of central necrosis.
 
Coronal view of an ipsilateral cervical nodal conglomerate (dotted arrows) predominantly at level II measuring 3.6 x 2 x 4.7 cm, exerting mass effect on the internal jugular vein. The nodes demonstrate central necrosis.
 
Maximum intensity projection image showed increased 18F-FDG uptake in the left tonsilar area, left cervical lymph nodes and left adrenal fossa (arrows).
 
Axial PET-CT images reveal asymmetric 18F-FDG uptake in the left tonsil (SUVmax 11.42) and left cervical nodes.
 
Axial PET-CT demonstrating multiple hypermetabolic foci in cervical lymphadenopathy (SUVmax of 19.07).
 
PET-CT multiplanar reconstructions demonstrating multiple hypermetabolic foci in cervical lymphadenopathy (SUVmax of 19.07).
 
Axial PET-CT shows an heterogeneous hypermetabolic 18F-FDG focus (SUVmax 20.86) at the upper pole of the left kidney with a hypometabolic central area.
 
The focus was consistent on coronal and sagittal fusion images with a 6.5cm left adrenal mass.
 
 
 
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