Use of MR sialography and T2W fat-suppressed series in parotitis

Phil Pretorius

doi:10.4102/sajr.v14i3.474

Abstract

Imaging can be helpful when investigating salivary gland pain and swelling. Typically in such cases, an ultrasound (US) or conventional sialogram would be requested in seeking obstructed or dilated ducts, a ductal calculus or an abscess within the gland. Occasionally a CT scan is requested. MR is usually reserved for investigating clinically palpable masses in the glands.  In acute non-obstructive parotitis, the differential diagnosis includes acute non-suppurative parotitis (as found in mumps), early Sjögren’s syndrome, or suppurative parotitis as seen following duct obstruction. Despite sometimes strong insistence on retrograde contrast sialography, this may exacerbate the pre-existing inflammatory process. The imaging of a young patient expands on these observations.

Highlights

Imaging can be helpful when investigating salivary gland pain and swelling
An MR sialogram was acquired through each parotid gland in an oblique sagittal orientation, which proved to be the most useful diagnostic sequence (Fig. 1)
The images from these sequences showed both parotid glands to be diffusely swollen with numerous microcysts within the gland parenchyma

Summary

Background

Imaging can be helpful when investigating salivary gland pain and swelling. In such cases, an ultrasound (US) or conventional sialogram would be requested in seeking obstructed or dilated ducts, a ductal calculus or an abscess within the gland. A computed tomography (CT) scan is requested. Magnetic resonance imaging (MRI) is usually reserved for investigating clinically palpable masses in the glands. In acute non-obstructive parotitis, the differential diagnosis includes acute non-suppurative parotitis (as found in mumps), early Sjögren’s syndrome, or suppurative parotitis as seen following duct obstruction. Sometimes there is strong insistence on retrograde contrast sialography; this may exacerbate the pre-existing inflammatory process.[1] The imaging of a young patient expands on these observations

Findings and diagnosis

Discussion

MR sialography