What do my PET-CT results mean with swollen lymph nodes?

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The PET-CT (positron emission tomography-computed tomography) scan shows high FDG (fluorodeoxyglucose) uptake in both palatine tonsils (attachment removed to protect the patient's identity), indicating the tonsils are using more energy than normal. This usually occurs with ongoing inflammation or infection, but in some cases, it can also be seen with cancers of the lymph system. There is also increased activity in the buccal mucosa, which is the inner lining of the mouth, suggesting irritation or inflammation.

Several cervical lymph nodes are also involved on both sides. Because these lymph nodes have been swollen for more than one year and now include areas such as the face, neck, arms, and armpits, this pattern suggests a body-wide (systemic) condition rather than a simple throat infection.

Possible causes include long-standing infections such as Epstein-Barr virus, cytomegalovirus, tuberculosis, or human immunodeficiency virus. Autoimmune diseases, where the immune system attacks the body (such as lupus or sarcoidosis), are also possible. Conditions affecting the lymph system, such as Hodgkin’s or non-Hodgkin’s lymphoma, must be ruled out as well.

The most important next step is a tissue biopsy, where a whole lymph node is surgically removed and examined under a microscope. This gives the most accurate diagnosis. A simple needle test may not provide enough information. In some cases, removal of a tonsil may also be advised.

Blood tests can help guide the diagnosis. These include tests to check blood cell counts, inflammation levels, signs of infection, immune system activity, and viral infections. In addition to the biopsy, these tests will help doctors identify the exact cause and choose the right treatment.

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