Background and Objective: The tonsils are the most commonly involved primary part of non-Hodgkins lymphoma (NHL) of the head and neck, which usually happens in the Waldeyers ring. Our study describes the features of computed tomography on enlarged tonsils as a first symptom of NHL and the characteristics of the involved cervical lymph nodes. Methods: A retrospective review was performed on 130 patients with primary extranodal lymphomas of the head and neck over 16 years. Of them 22 untreated patients showed tonsil lesions as a first symptom. Results: Bilateral enlarged tonsils were involved in 13 patients, and unilateral lesions were in 9 patients. The lesions in 20 patients appeared mass-like, while 2 patients had diffuse thickening. There were 8 patients with simultaneous invasion of the nasopharynx, soft palate, and epiglottis. Of the 19 patients that underwent enhanced CT scans, 15 patients demonstrated slight homogeneous enhancement, 4 with crannied or a patch of low density, and 1 with ring-like enhancement. All 22 patients appeared to have cervical lymph nodes involvement. The upper groups of cervical lymph nodes were involved bilaterally in 13 patients, unilaterally in 9 patients. The middle groups were involved bilaterally in 7 patients, unilaterally in 10 patients. The lower groups were involved bilaterally in 2 patients, and unilaterally in 5 patients. After contrast administration, lymph nodes showed homogeneous density and slight enhancement in 11 patients, heterogeneous enhancement with necrosis and cystic changes in 6 patients, and ring-like enhancement in 2 patients. Conclusions: Bilateral involvement, homogeneous density, and slight enhancement are characteristics of tonsil involvement of non-Hodgkins lymphoma. Bilateral upper groups of cervical lymph nodes are the most frequently involved lymph nodes, which are often shown with homogeneous density and slight enhancement.