A 46-year-old man was referred to our institution for evaluation of a cystic lesion in the maxilla, which was identified at another medical institution. One year prior to visiting our hospital, the patient became aware of swelling in the alveolar part of the maxillary anterior tooth and received incision and drainage treatment. The patient later visited our institution to have a follow-up examination owing to persisted swelling. The patient had a clear medical history. Initial physical examination revealed swelling of the alveolar part of the maxillary anterior tooth and purulent discharge from the maxillary mesial palate. The patient had normal laboratory examinations without any abnormal data. Panoramic radiographic images revealed well-defined and unilocular transmission images of the left maxillary lateral incisor to the right maxillary second premolar, as well as an oval radiopaque lesion mimicking sialolithiasis under the right side of the mandible. Non-contrast computed tomography (CT) showed a similar lesion as mentioned above. The maxillary cyst was diagnosed as a radicular cyst on diagnostic imaging. A calcified body was observed near the opening of the subman-dibular gland, but not in the cervical lymph nodes. It showed a mass composed of multiple small foci of calcification with a non-layer structure, which is a typical feature of sialolithiasis[,]. Swelling of the peripheral lymph nodes and the mass that appeared to be the submandibular gland were also observed without any symptoms at this time, although a slight palpable solid lesion existed. Considering the possibility of a tumor, we performed contrast-enhanced CT (CECT) and ultrasonography. CECT images revealed that the peripheral lymph nodes, existing in the submandibular lymph node, superior internal jugular node, and mid-internal jugular node, exhibited a central area of low attenuation state with rim enhancement. In addition, fusion of these lymph nodes was present at multiple sites. All the affected nodes mimicked a similar pattern, suggestive of tuberculous cervical lymphadenitis, for which the typical observation mainly displays low attenuation at the center with rim enhancement; this represents the central area of necrosis, although this finding is also similar to that of metastatic lymph nodes[,]. Ultrasonography revealed the findings of the imaging, such as preserved oval shape, absence of peripheral halo, and internal echogenicity, which is suspicious of tuber-culous cervical lymphadenitis or metastatic lymph nodes, whereas a QuantiFERON Gold blood test yielded a negative result, and there was no suspicious lesion on chest radiography. This ultrasonographic finding is rather atypical of metastatic disease (preservation of oval shape, existence of hilus in the enlarged lymph nodes, and relatively well-defined margins).