Syphilis CT

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: ; Aysha Anwar, M.B.B.S[2]; Vishal Devarkonda, M.B.B.S[3]; Tarek Nafee, M.D. [4]

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Overview

CT scan is not diagnostic of syphilis. However, non-specific CT findings may demonstrate complications of syphilis including pulmonary, cardiac, neurological, gastrointestinal, and bone findings.

CT

On CT scan, syphilis may present with various findings including:

Pulmonary

  • Solitary or multiple pulmonary nodules with or without infiltrates (mimicking pulmonary metastasis)[1]
  • Round, well-defined opacities[2][1]
  • Pleural effusion[1]

Cardiac

  • Double ring appearance of the aortic wall with a hyper-dense outer rim and hypo-dense inner rim[3][4]
  • Thickening or calcification appearing as contrast enhancement of aortic wall[3][4]

Neurological



Bone

  • Lytic bone lesions in tibia, acromion, ribs, and sacroiliac joint[5]\
  • Multiple lytic lesions in the skull in early syphilis[6]

Gastrointestinal

  • Irregular rectal wall thickening (mimicking rectal carcinoma)[7]
  • Multiple peri-rectal lymph node enlargement (mimicking rectal carcinoma)[7]

Others

  • Perivascular fluid collection
  • Peri aortic lymph node enlargement

References

  1. 1.0 1.1 1.2 Kim HJ, Seon HJ, Shin HH, Choi YD (2011). "Case report: Pulmonary syphilis mimicking pulmonary hematogenous metastases on chest CT and integrated PET/CT". Indian J Radiol Imaging. 21 (1): 34–7. doi:10.4103/0971-3026.76052. PMC 3056368. PMID 21431031.
  2. David G, Perpoint T, Boibieux A, Pialat JB, Salord H, Devouassoux M; et al. (2006). "Secondary pulmonary syphilis: report of a likely case and literature review". Clin Infect Dis. 42 (3): e11–5. doi:10.1086/499104. PMID 16392072.
  3. 3.0 3.1 Kimura F, Satoh H, Sakai F, Nishii N, Tohda J, Fujimura M; et al. (2004). "Computed tomographic findings of syphilitic aortitis". Cardiovasc Intervent Radiol. 27 (2): 179–81. PMID 15259819.
  4. 4.0 4.1 Agarwal PP, Chughtai A, Matzinger FR, Kazerooni EA (2009). "Multidetector CT of thoracic aortic aneurysms". Radiographics. 29 (2): 537–52. doi:10.1148/rg.292075080. PMID 19325064.
  5. Bezalely S, Jacob G, Flusser G, Ablin J (2014). "Syphilis: an unusual manifestation?". BMJ Case Rep. 2014. doi:10.1136/bcr-2014-204871. PMC 4170241. PMID 25239989.
  6. Huang I, Leach JL, Fichtenbaum CJ, Narayan RK (2007). "Osteomyelitis of the skull in early-acquired syphilis: evaluation by MR imaging and CT". AJNR Am J Neuroradiol. 28 (2): 307–8. PMID 17297001.
  7. 7.0 7.1 Cha JM, Choi SI, Lee JI (2010). "Rectal syphilis mimicking rectal cancer". Yonsei Med J. 51 (2): 276–8. doi:10.3349/ymj.2010.51.2.276. PMC 2824876. PMID 20191023.


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