Herpes zoster other imaging findings

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2]

Overview

Imaging is not routinely done to diagnose herpes zoster infection. However, it may be used as part of the work-up of the several but rare complications of herpes zoster infection.

Other Imaging Findings

PET/CT

A PET/CT scan can present with focal skin lesions and/or reactive lymph node enlargement, with increased FDG (2-deoxy-2[18F]fluro-D-glucose) uptake. Local reactive adenopathy is an important finding on PET/CT scan in patients with herpes zoster infection, but must be correlated with the pertinent skin findings.^[1]

MRI

MRI may be used to provide clues for the diagnosis of herpes zoster infection and its complications. However, it is not routinely done in the diagnosis of the infection. Some of the complications and their associated MRI findings include:^[2]^[3]

Ramsay Hunt Syndrome: in Ramsay Hunt Syndrome, cranial nerve VII appears hyperintense
Cerebellitis: may show diffuse symmetric abnormal high signal intensity and swelling of the cerebellar cortex
Vasculitis: MRI may show an area of infarction of the cerebral cortex
Myelitis: spinal cord lesions appear as hyperintense
In rare cases of chronic active herpes zoster infection, MRI shows extensive swelling and enhancement of the involved dorsal root ganglion and nerve roots

References

↑ Wadih A, Rehm PK, Deng C, Douvas M (2015). “Active herpes zoster infection with cutaneous manifestation and adenopathy on FDG PET/CT”. Radiol Case Rep. 10 (3): 27–9. doi:10.1016/j.radcr.2015.06.006. PMC 4634351. PMID 26649113.
↑ Soares BP, Provenzale JM (2016). “Imaging of Herpesvirus Infections of the CNS”. AJR Am J Roentgenol. 206 (1): 39–48. doi:10.2214/AJR.15.15314. PMID 26700334.
↑ Blumenthal DT, Salzman KL, Baringer JR, Forghani B, Gilden DH (2004). “MRI abnormalities in chronic active varicella zoster infection”. Neurology. 63 (8): 1538–9. PMID 15505191.

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[pmid26649113-1] Wadih A, Rehm PK, Deng C, Douvas M (2015). “Active herpes zoster infection with cutaneous manifestation and adenopathy on FDG PET/CT”. Radiol Case Rep. 10 (3): 27–9. doi:10.1016/j.radcr.2015.06.006. PMC 4634351. PMID 26649113.

[pmid26700334-2] Soares BP, Provenzale JM (2016). “Imaging of Herpesvirus Infections of the CNS”. AJR Am J Roentgenol. 206 (1): 39–48. doi:10.2214/AJR.15.15314. PMID 26700334.

[pmid15505191-3] Blumenthal DT, Salzman KL, Baringer JR, Forghani B, Gilden DH (2004). “MRI abnormalities in chronic active varicella zoster infection”. Neurology. 63 (8): 1538–9. PMID 15505191.

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