Syphilis CT

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.

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

Solitary or multiple pulmonary nodules with or without infiltrates (mimicking pulmonary metastasis)^[1]
Round, well-defined opacities^[1]^[7]
Pleural effusion^[1]

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

Lytic bone lesions in tibia, acromion, ribs, and sacroiliac joint^[4]
Multiple lytic lesions in the skull in early syphilis^[5]

Gastrointestinal

Irregular rectal wall thickening (mimicking rectal carcinoma)^[6]
Multiple peri-rectal lymph node enlargement (mimicking rectal carcinoma)^[6]

Others

Perivascular fluid collection
Periaortic lymph node enlargement

References

↑ ^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.
↑ ^2.0 ^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.
↑ ^3.0 ^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.
↑ ^4.0 ^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.
↑ ^5.0 ^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.
↑ ^6.0 ^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.
↑ 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.
↑ 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.
↑ 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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[pmid21431031-1] 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.

[pmid15259819-2] 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.

[pmid19325064-3] 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.

[pmid25239989-4] 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.

[pmid17297001-5] 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.

[pmid20191023-6] 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.

[pmid16392072-7] 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.

[pmid17628376-8] 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.

[pmid7611026-9] 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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