FDG PET CT shows increased uptake in the soft tissue structure that extends from the sphenoid sinus into the ethmoid sinus which can be secondary to neoplastic or inflammatory process. But since this patient has pathologically enlarged lymph nodes, a neoplastic process cannot be excluded. Tissue sampling was indicated for further evaluation.FDG: fludeoxyglucose, PET: positron emission tomography, CT: computed tomography