Sonographic appearance immunoglobulin G4-related submandibular gland disease in adult patients

Abstract

Objective To analyze and summarize the sonographic features of immunoglobulin G4(IgG4)-related submandibular gland disease. Methods The retrospective analysis on the sonographic results of 22 lesions in 19 patients with IgG4-related submandibular gland disease were conducted, including submandibular gland size, shape, lesion range, internal echo, blood flow, and peripheral lymph nodes. Results The sonographic features of 22 lesions of IgG4-related submandibular gland disease were classified into localized nodule changes, diffuse nodule changes, and tumor-forming changes. The localized nodule appearance, includes 2 lesions in 2 patients, shows a hypo-echoic area with a coarse echotexture in the superficial site of the gland and rich blood flow. In the diffuse nodule appearance, includes 12 lesions in 11 patients, the gland shows an irregular net or honeycomb structure. Further, the gland shows echo enhancement, thickening, uneven, and rich blood flow with the features of multiple, variously sized hypoechoic foci and surrounding parallel echogenic foci. The tumor-forming appearance, includes 8 lesions in 7 patients, shows the decrease of echogenic heterogeneity, coarse gland texture, multiple parallel echogenicity, and rich blood flow. Conclusions Ultrasonography can be used as the preferred diagnostic method for IgG4-related submandibular gland disease. When a patient is suspected of having IgG4-related submandibular gland disease, the tissues and organs often involved in IgG4 related diseases should be further examined, meanwhile conducting ultrasound-guided biopsy. Key words: IgG4-related disease; Submandibular gland; Ultrasonography