Standard delayed whole-body gallium scan demonstrates abnormal focal activity bilaterally in the hilar, paratracheal, and inguinal regions, compatible with lymph node uptake (circles). Focal tracer uptake is also seen in the lacrimal, nasal, and submandibular salivary regions (arrows). Normal gallium uptake is seen in the liver and bone marrow. Typically, the spleen demonstrates mild gallium uptake; however, this patient has had a splenectomy.

Differential Diagnosis

Gallium is a nonspecific agent, and abnormal uptake can be seen with infection, tumor, and granulomatous disease such as sarcoid.

•  Gallium scan showing sarcoid: The symmetric uptake in a hilar and paratracheal lymph node distribution (“lambda” sign) as well as prominent lacrimal and salivary uptake favor sarcoid, even though the inguinal lymph node uptake is less typical and makes lymphoma another good possibility.

•  Tumor: