Palatine Tonsils
The palatine tonsils frequently demonstrate very intense metabolic activity.
Interpretation of tonsillar uptake is depends on the clinical presentation of the patient, the degree of FDG uptake, the size of the tonsils and the bilateral or unilateral nature of the findings.
- Bilateral and fairly symmetric FDG-uptake in non-enlarged palatine tonsils is almost always a normal finding.
- Bilateral and fairly symmetric FDG-uptake in enlarged palatine tonsils is nearly always inflammatory in nature (although can occasionally be seen with lymphoma).
- Unilateral or asymmetric increased FDG uptake within one palatine tonsil warrants careful and detailed assessment (addressed in detail, here).
Case 1
Case 1 (Image 2)
Fused axial image of normal symmetric intense uptake in bilateral non-enlarged palatine tonsils. This nearly always represents normal physiologic uptake.
Case 1 (Image 3)
Fused axial image of normal symmetric intense uptake in bilateral non-enlarged palatine tonsils. This nearly always represents normal physiologic uptake.
Case 1 (Image 4)
Fused axial image of normal symmetric intense uptake in bilateral non-enlarged palatine tonsils. This nearly always represents normal physiologic uptake.
Case 1 (Image 5)
Case 2
Case 2 (Image 2)
Fused axial image of symmetric intense uptake in bilateral enlarged palatine tonsils. This is nearly always inflammatory in nature, although this appearance can occasionally be seen with active lymphoma. The uptake seen in the anterior mouth/tongue is normal.
Case 2 (Image 3)
Case 3
Case 3 (Image 2)
Post-treatment scan (same case as Image 2) demonstrates complete resolution of the patient’s active lymphoma, including the tonsillar disease noted on the prior exam.
Case 4
Case 4 (Image 2)
Axial CT image demonstrates non-enlarged bilateral palatine tonsils, fairly symmetric in size.
Case 4 (Image 3)
Fused axial image demonstrates unilateral intense FDG uptake involving the left palatine tonsil. This appearance is usually physiologic or inflammatory in nature.
Case 4 (Image 4)
CT and fused axial images demonstrating this not uncommon finding of unilateral intense uptake in a non-enlarged palatine tonsil.
Case 5
Case 5 (Image 2)
Unilateral intense uptake involving the left palatine tonsil, which is mildly enlarged. While this appearance is usually inflammatory in nature, biopsy revealed a tonsillar carcinoma.
Case 5 (Image 3)
Unilateral increased FDG uptake involving the right palatine tonsil, which is mildly prominent in size. As this is only moderately avid (certainly less avid than the prior two cases), this is almost certainly inflammatory in nature (confirmed upon inspection).