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.

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## Overview

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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

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

### Pulmonary

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

### Cardiac

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* 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

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* 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

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

### Gastrointestinal

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

### Others

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* Perivascular fluid collection
* Periaortic lymph node enlargement

## References

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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.CS1 maint: Multiple names: authors list (link)
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.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
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.CS1 maint: Multiple names: authors list (link)
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.CS1 maint: Multiple names: authors list (link)
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.CS1 maint: Multiple names: authors list (link)
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.CS1 maint: Multiple names: authors list (link)
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.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
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.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
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.CS1 maint: Multiple names: authors list (link)

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