Syphilis CT: Difference between revisions

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__NOTOC__
__NOTOC__
{{CMG}}{{AE}}; {{AA}} {{VD}}
{{CMG}}; {{AE}}; {{AA}}; {{VD}}; {{TarekNafee}}; {{NRM}}
{{Syphilis}}
{{Syphilis}}
==Overview==
==Overview==
CT scan may be helpful in diagnosis of Syphilis. Findings of CT scan which are suggestive of Syphilis include the following.
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.<ref name="pmid21431031">{{cite journal| author=Kim HJ, Seon HJ, Shin HH, Choi YD| title=Case report: Pulmonary syphilis mimicking pulmonary hematogenous metastases on chest CT and integrated PET/CT. | journal=Indian J Radiol Imaging | year= 2011 | volume= 21 | issue= 1 | pages= 34-7 | pmid=21431031 | doi=10.4103/0971-3026.76052 | pmc=3056368 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21431031  }} </ref><ref name="pmid15259819">{{cite journal| author=Kimura F, Satoh H, Sakai F, Nishii N, Tohda J, Fujimura M et al.| title=Computed tomographic findings of syphilitic aortitis. | journal=Cardiovasc Intervent Radiol | year= 2004 | volume= 27 | issue= 2 | pages= 179-81 | pmid=15259819 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15259819  }} </ref><ref name="pmid19325064">{{cite journal| author=Agarwal PP, Chughtai A, Matzinger FR, Kazerooni EA| title=Multidetector CT of thoracic aortic aneurysms. | journal=Radiographics | year= 2009 | volume= 29 | issue= 2 | pages= 537-52 | pmid=19325064 | doi=10.1148/rg.292075080 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19325064  }} </ref><ref name="pmid25239989">{{cite journal| author=Bezalely S, Jacob G, Flusser G, Ablin J| title=Syphilis: an unusual manifestation? | journal=BMJ Case Rep | year= 2014 | volume= 2014 | issue=  | pages=  | pmid=25239989 | doi=10.1136/bcr-2014-204871 | pmc=4170241 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25239989  }} </ref><ref name="pmid17297001">{{cite journal| author=Huang I, Leach JL, Fichtenbaum CJ, Narayan RK| title=Osteomyelitis of the skull in early-acquired syphilis: evaluation by MR imaging and CT. | journal=AJNR Am J Neuroradiol | year= 2007 | volume= 28 | issue= 2 | pages= 307-8 | pmid=17297001 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17297001  }} </ref><ref name="pmid20191023">{{cite journal| author=Cha JM, Choi SI, Lee JI| title=Rectal syphilis mimicking rectal cancer. | journal=Yonsei Med J | year= 2010 | volume= 51 | issue= 2 | pages= 276-8 | pmid=20191023 | doi=10.3349/ymj.2010.51.2.276 | pmc=2824876 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20191023  }} </ref>
 
==CT ==
==CT ==
On CT, Syphilis may present with various findings including:<ref name="pmid15259819">{{cite journal| author=Kimura F, Satoh H, Sakai F, Nishii N, Tohda J, Fujimura M et al.| title=Computed tomographic findings of syphilitic aortitis. | journal=Cardiovasc Intervent Radiol | year= 2004 | volume= 27 | issue= 2 | pages= 179-81 | pmid=15259819 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15259819  }} </ref>
On CT scan, syphilis may present with various non-specific findings including:
===Pulmonary===
===Pulmonary===
* Solitary or multiple pulmonary nodules with or without infiltrates
* Solitary or multiple pulmonary nodules with or without infiltrates (mimicking [[pulmonary metastasis]])<ref name="pmid21431031">{{cite journal| author=Kim HJ, Seon HJ, Shin HH, Choi YD| title=Case report: Pulmonary syphilis mimicking pulmonary hematogenous metastases on chest CT and integrated PET/CT. | journal=Indian J Radiol Imaging | year= 2011 | volume= 21 | issue= 1 | pages= 34-7 | pmid=21431031 | doi=10.4103/0971-3026.76052 | pmc=3056368 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21431031  }} </ref>
* Pleural effusion
*Round, well-defined opacities<ref name="pmid21431031">{{cite journal| author=Kim HJ, Seon HJ, Shin HH, Choi YD| title=Case report: Pulmonary syphilis mimicking pulmonary hematogenous metastases on chest CT and integrated PET/CT. | journal=Indian J Radiol Imaging | year= 2011 | volume= 21 | issue= 1 | pages= 34-7 | pmid=21431031 | doi=10.4103/0971-3026.76052 | pmc=3056368 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21431031  }} </ref><ref name="pmid16392072">{{cite journal| author=David G, Perpoint T, Boibieux A, Pialat JB, Salord H, Devouassoux M et al.| title=Secondary pulmonary syphilis: report of a likely case and literature review. | journal=Clin Infect Dis | year= 2006 | volume= 42 | issue= 3 | pages= e11-5 | pmid=16392072 | doi=10.1086/499104 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16392072  }} </ref>
* [[Pleural effusion]]<ref name="pmid21431031">{{cite journal| author=Kim HJ, Seon HJ, Shin HH, Choi YD| title=Case report: Pulmonary syphilis mimicking pulmonary hematogenous metastases on chest CT and integrated PET/CT. | journal=Indian J Radiol Imaging | year= 2011 | volume= 21 | issue= 1 | pages= 34-7 | pmid=21431031 | doi=10.4103/0971-3026.76052 | pmc=3056368 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21431031  }} </ref>
 
===Cardiac===
===Cardiac===
*Double ring appearance of the Aortic wall with a hyper-dense outer rim and hypo-dense inner rim.
*Double ring appearance of the aortic wall with a hyperdense outer rim and hypodense inner rim<ref name="pmid15259819">{{cite journal| author=Kimura F, Satoh H, Sakai F, Nishii N, Tohda J, Fujimura M et al.| title=Computed tomographic findings of syphilitic aortitis. | journal=Cardiovasc Intervent Radiol | year= 2004 | volume= 27 | issue= 2 | pages= 179-81 | pmid=15259819 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15259819  }} </ref><ref name="pmid19325064">{{cite journal| author=Agarwal PP, Chughtai A, Matzinger FR, Kazerooni EA| title=Multidetector CT of thoracic aortic aneurysms. | journal=Radiographics | year= 2009 | volume= 29 | issue= 2 | pages= 537-52 | pmid=19325064 | doi=10.1148/rg.292075080 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19325064  }} </ref>
*Thickening or calcification of Aortic wall.
*Thickening or calcification appearing as contrast enhancement of aortic wall<ref name="pmid15259819">{{cite journal| author=Kimura F, Satoh H, Sakai F, Nishii N, Tohda J, Fujimura M et al.| title=Computed tomographic findings of syphilitic aortitis. | journal=Cardiovasc Intervent Radiol | year= 2004 | volume= 27 | issue= 2 | pages= 179-81 | pmid=15259819 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15259819  }} </ref><ref name="pmid19325064">{{cite journal| author=Agarwal PP, Chughtai A, Matzinger FR, Kazerooni EA| title=Multidetector CT of thoracic aortic aneurysms. | journal=Radiographics | year= 2009 | volume= 29 | issue= 2 | pages= 537-52 | pmid=19325064 | doi=10.1148/rg.292075080 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19325064  }} </ref>
*Arterial enhancement of Aorta.
===Neurological===
===Head===
*Areas of decreased density suggesting cerebral infarction<ref name="pmid17628376">{{cite journal| author=Peng F, Hu X, Zhong X, Wei Q, Jiang Y, Bao J et al.| title=CT and MR findings in HIV-negative neurosyphilis. | journal=Eur J Radiol | year= 2008 | volume= 66 | issue= 1 | pages= 1-6 | pmid=17628376 | doi=10.1016/j.ejrad.2007.05.018 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17628376  }} </ref><ref name="pmid7611026">{{cite journal| author=Brightbill TC, Ihmeidan IH, Post MJ, Berger JR, Katz DA| title=Neurosyphilis in HIV-positive and HIV-negative patients: neuroimaging findings. | journal=AJNR Am J Neuroradiol | year= 1995 | volume= 16 | issue= 4 | pages= 703-11 | pmid=7611026 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7611026  }} </ref>
*Multifocal infarction with variable enhancement.
*Syphilitic [[gumma]] appear hypodense with precontrast
*Focal or diffuse extraaxial enhancement
*Non-specific white matter lesions
===Bone===
*Lytic bone lesions in [[tibia]], [[acromion]], [[ribs]], and [[sacroiliac joint]]<ref name="pmid25239989">{{cite journal| author=Bezalely S, Jacob G, Flusser G, Ablin J| title=Syphilis: an unusual manifestation? | journal=BMJ Case Rep | year= 2014 | volume= 2014 | issue=  | pages=  | pmid=25239989 | doi=10.1136/bcr-2014-204871 | pmc=4170241 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25239989  }} </ref>
*Multiple lytic lesions in the skull in early syphilis<ref name="pmid17297001">{{cite journal| author=Huang I, Leach JL, Fichtenbaum CJ, Narayan RK| title=Osteomyelitis of the skull in early-acquired syphilis: evaluation by MR imaging and CT. | journal=AJNR Am J Neuroradiol | year= 2007 | volume= 28 | issue= 2 | pages= 307-8 | pmid=17297001 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17297001  }} </ref>
===Gastrointestinal===
*Irregular rectal wall thickening (mimicking [[rectal carcinoma]])<ref name="pmid20191023">{{cite journal| author=Cha JM, Choi SI, Lee JI| title=Rectal syphilis mimicking rectal cancer. | journal=Yonsei Med J | year= 2010 | volume= 51 | issue= 2 | pages= 276-8 | pmid=20191023 | doi=10.3349/ymj.2010.51.2.276 | pmc=2824876 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20191023  }} </ref>
*Multiple peri-rectal lymph node enlargement (mimicking [[rectal carcinoma]])<ref name="pmid20191023">{{cite journal| author=Cha JM, Choi SI, Lee JI| title=Rectal syphilis mimicking rectal cancer. | journal=Yonsei Med J | year= 2010 | volume= 51 | issue= 2 | pages= 276-8 | pmid=20191023 | doi=10.3349/ymj.2010.51.2.276 | pmc=2824876 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20191023  }} </ref>
 
===Others===
===Others===
*Perivascular fluid Collection
*Perivascular fluid collection
*Peri aortic lymph node
*Periaortic [[lymph node]] enlargement


==References==
==References==
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[[Category:Gynecology]]
[[Category:Gynecology]]
[[Category:Emergency mdicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
[[Category:Primary care]]
[[Category:Urology]]
[[Category:Neurology]]

Latest revision as of 00:23, 30 July 2020

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]; Nate Michalak, B.A.

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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.[1][2][3][4][5][6]

CT

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

Pulmonary

Cardiac

  • Double ring appearance of the aortic wall with a hyperdense outer rim and hypodense inner rim[2][3]
  • Thickening or calcification appearing as contrast enhancement of aortic wall[2][3]

Neurological

  • Areas of decreased density suggesting cerebral infarction[8][9]
  • Syphilitic gumma appear hypodense with precontrast
  • Focal or diffuse extraaxial enhancement
  • Non-specific white matter lesions

Bone

Gastrointestinal

Others

  • Perivascular fluid collection
  • Periaortic lymph node enlargement

References

  1. ↑ 1.0 1.1 1.2 1.3 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. ↑ 2.0 2.1 2.2 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.
  3. ↑ 3.0 3.1 3.2 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.
  4. ↑ 4.0 4.1 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.
  5. ↑ 5.0 5.1 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.
  6. ↑ 6.0 6.1 6.2 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.
  7. ↑ 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.
  8. ↑ Peng F, Hu X, Zhong X, Wei Q, Jiang Y, Bao J; et al. (2008). "CT and MR findings in HIV-negative neurosyphilis". Eur J Radiol. 66 (1): 1–6. doi:10.1016/j.ejrad.2007.05.018. PMID 17628376.
  9. ↑ Brightbill TC, Ihmeidan IH, Post MJ, Berger JR, Katz DA (1995). "Neurosyphilis in HIV-positive and HIV-negative patients: neuroimaging findings". AJNR Am J Neuroradiol. 16 (4): 703–11. PMID 7611026.


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