Pharyngeal diphtheria

Case contributed by Hoe Han Guan


Sorethroat with right sided neck swelling for 3 days.

Patient Data

Age: 50 years
Gender: Female

The right tonsil appears to be asymmetrically enlarged with striated enhancement pattern (tiger-stripe appearance). Diffuse abnormal enhancement area is also noted at the tongue base and right lateral oro-pharyngeal wall with irregular surface representing enhancement at part of Waldeyer ring. No abnormal enhancing collection noted to suggest peritonsillar abscess. Slight increased of fat streakiness in right parapharyngeal space. No retropharyngeal or danger space collection.

Enlarged enhancing lymph nodes seen at the bilateral cervical level II regions, the largest on the right level II measures 1.7cm in short axis diameter (SAD) and on the left side measures 1.2cm in SAD. Subcentimeter lymph nodes in other cervical levels.

Epiglottis is not thickened or swollen. Airway are not significantly narrowed.

Vessels in both carotid spaces are well opacified.

Both fossa of Rossenmueller are normal.

Annotated image

Annotated images showed bilateral cervical level II lymphadenopathy, base of tongue enhancement (part of Waldeyer ring) and tiger stripe appearance of right palatine tonsil.

Case Discussion

Overall CT features are suggestive of acute tonsilitis with bilateral level II cervical lymphadenopathy. The diffuse enhancement of the Waldeyer ring may represent lymphoid hyperplasia as an inflammatory/infective response.

Corynebacterium diphtheriae was detected by bacterial culture and with positive findings by virulence test, this case was proven to be pharyngeal diphtheria. Further history revealed that she does not receive full vaccination.

Diphtheria is a serious bacterial infection that affects the mucous membranes of the nose and throat. Diphtheria is extremely rare in developed countries due to successful widespread vaccination against the disease. However, this disease is still prevalent in developing countries where vaccination uptake is lower. 

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