Abstract
Ultrasonography has become a valuable tool for the assessment of salivary gland involvement in Sjögren syndrome. Diagnostic pitfalls can be encountered in late stages of the disease, in which morphologic changes may overlap with other pathologies of the salivary glands. We present the case of a female Sjögren syndrome patient with lack of significant sicca symptoms and unilateral occurrence of parotidomegaly, which prompted the suspicion of a parotid gland tumor. Due to the atypical clinical profile, diagnosis of Sjögren syndrome was delayed, at which point, severe sialadenitis produced a cystic transformation of the parotid gland parenchyma.
Highlights
The ultrasound (US) assessment of parotid glands (PG) has become a common practice in the diagnostic work-up of Sjögren syndrome (SS) patients
Diagnostic difficulties may be encountered if advanced structural changes have developed, and if imaging features mimic other PG pathologies, such as neoplastic or granulomatous disease [3]
We present the case of a female SS patient with scarce clinical symptoms, initially diagnosed with salivary gland tumor, in which the severe sialadenitis displayed atypical US features, with a predominantly cystic-like pattern
Summary
The ultrasound (US) assessment of parotid glands (PG) has become a common practice in the diagnostic work-up of Sjögren syndrome (SS) patients. The hallmark US feature in SS is parenchymal inhomogeneity (PIH), a structural change that occurs as a result of local lymphocytic infiltrate [1]. Appropriate evaluation by a rheumatologist may be greatly delayed in patients who tolerate a casual xerostomia or lack sicca symptoms altogether. Diagnostic difficulties may be encountered if advanced structural changes have developed, and if imaging features mimic other PG pathologies, such as neoplastic or granulomatous disease [3]. We present the case of a female SS patient with scarce clinical symptoms, initially diagnosed with salivary gland tumor, in which the severe sialadenitis displayed atypical US features, with a predominantly cystic-like pattern
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