The Angry Torus: Osteoradionecrosis Resulting in a Potential Positron-Emission Tomography/CT Pitfall

A 59-year-old woman, status post resection of a sinonasal carcinoma, underwent staging PET/CR, which showed increased FDG uptake in multiple areas, including the hard palate. Histologic results from several biopsy sites confirmed metastatic tumor, but only acute-on-chronic inflammation in the palate. One percent of the population has a bony overgrowth at the palatine suture, a torus palatinus. A combination of oral trauma and radiation therapy may predispose the torus palatinus to become inflamed, with resultant increased FDG uptake on PET/CT. This, in turn, may lead to a false-positive interpretation. Given the morbidity associated with osteoradionecrosis, unnecessary biopsy is contraindicated, and radiologists should be aware of an inflamed (angry) torus palatinus to avoid a potential imaging pitfall.