Salivary Gland Radiology Presentation

8/9/2019 Salivary Gland Radiology Presentation

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Salivary glandsradiology

DONE BYIBRAHIM AMER


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e!"anis o#

salivary glandDental diagnosticians haveresponsibility for detecting disordersof the salivary glands

A familiarity with salivary glanddisorders and

applicable current imagingtechniques is an essential element ofthe clinician ’ s armamentarium .


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Disease e!"anis

o# salivary glandinammatory disordersInmmatory disorders are acute or chronic and may besecondary to ductal obstruction by sialoliths, trauma,

infection, or space-occupying lesions such as neoplasia.

on ! inammatory disordersare metabolic and secretory abnormalities associated with

diseases of nearly all the endocrine glands, malnutrition, andneurologic disorders

.

space-occupying masses.

are cystic or neoplastic" the neoplasms arebenign or malignant.


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$lini!al Signs

and Sy%&osDisease of ma#or salivary glands may havesingle or multiple feature $-

A. %welling in the area of parotid andsubmandibular gland

&. 'ain and altered salivary ow

(. )he periodicity and longevity of these

symptomsD. a review of the medical history and physical

condition of the patient may provideimportant information.


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Di'eren&ial

Diagnosis

o# Salivary Enlargeen&s


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eren a agnos s (aro&id )land Area* o# Salivary

Enlargeen&s

BI+A,ERA+ -NI+A,ERA+

&acterial sialadenitis *iral sialadenitis+mumps %#gren syndrome

Alcoholic hypertrophy edication-inducedhypertrophy +iodine,heavy metals

/uman immunode0ciency virus ! associatedmulticentriccysts asseter muscle

hypertrophy

Bacterialsialadenitis Sialodochitis

Cyst Benign neoplasm Malignantneoplasm

Intraglandularlymph node Masseter musclehypertrophy

Lesions of adjacent

Di' i l Di i


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Di'eren&ial Diagnosis S./andi/.lar Area* o#Salivary Enlargeen&s

BI+A,ERA+ -I+A,ERA+

&acterialsialadenitis %#grensyndrome 1ymphadenitis &ranchial cleftcyst %ubmandibular

&acterialsialadenitis %ialodochitis 2ibrosis (yst &enignneoplasm alignantneo lasm


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Iaging

o# &"e Salivary)landsDiagnostic imaging of salivary glanddisease may be underta3en to

di4erentiate inammatory processes fromneoplastic disease .

di4use disease from focal suppurativedisease, identify and locali5e sialoliths,and demonstrate ductal morphologyanddetermine the anatomic location of atumor, in addition , di4erentiate benign

from malignant tumor .


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IN,RAORA+


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IN,RAORA+

RADIO)RA(HY %ialoliths in the anterior two thirds of the submandibular duct aretypically imaged with a cross-sectional mandibular occlusalpro#ection

)he posterior part of the duct is demonstrated with an over-the-shoulder occlusal pro#ection view, where the directing cone isplaced on the shoulder and central

ray directed in an anterior direction through the angle of themandible, with the patient ’ s head tilted to the una4ected sideand rotated bac3 .

'arotid sialoliths are more di7cult to demonstrate than thesubmandibular variety as a result of the tortuous course of%tensen duct around the anterior border of the masseter andthrough the buccinator muscle. As a r.le1 only sialoli&"s an&erior&o &"e asse&er .s!le

!an /e iaged on an in&raoral 2l3


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o!!l.sal radiogra%"deons&ra&ing radio%a.e

sialoli&" in6"ar&on d.!& No&e &"e

!lassi! laina&ed

a%%earan!e.

.


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(eria%i!alradiogra%"s o# &"esae !ase ,"eradio%a.e!al!.l.s !an /elo!ali7ed ling.al &o&"e &ee&" /y

a%%lyinga ro ria&e o/ e!&


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An a4ial /one algori&" $,iage s"oing a sialoli&" in

&"e s./andi/.lar d.!&:arro9; .


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E


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E


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S&ereos!o%i! %anorai!

%lain l%ro8e!&ion.

%tereoscopic panoramic plain 0 lmpro#ection. ote the laminatedappearance of this sialolith in the submandibular

gland. )heimage of the sialolith is magni0 edbecause of itsrelatively lingual placement in theimage layer. )a3en from slightly di4erent

hori5ontal angles, athree-dimensional appearance can be


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Over*&"es"o.ldero!!l.sal%ro8e!&ionrevealing asialoli&"


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Anteroposteriors3ull view withchee3 blown

out to provideair contrast toreveal a parotidsialolith(arrow).


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(ropped panoramicradiograph

'arotid sialolithsuperimposed overcondylar nec3++arrow is

superior to theplane of occlussionwhich di4erentiatefrom palatinetonsillolith


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(ropped panoramicradiograph

%ubmandibularsialolith +arrow near the

antagonial notchof the mandibularand superior tothe hyoid bone


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+SIA+O)RA(HY 2irst performed in 9:; 0lm is usually made before the infusion of the

contrast solution into the ductal system

.

?ith this technique, 1ipid-soluble +e.g., @thiodol or non !1ipid-soluble+e.g., %inogra0 n contrast solution is then slowly infused

until the patient feels discomfort +usually between ;.< and 9. ml.


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+

SIA+O)RA(HY )hese iodine-containing agents render the ductal systemradiopaque, )he image of the ductal system appears as = treelimbs, > with no area of the gland devoid of ducts. ?ith acinar

0lling, the = tree > comes into = bloom, > which is the typicalappearance of the parenchymal opaci0cation phase .

on ! lipid-soluble contrast agents are preferred because ofreports of inammatory reactions subsequent to inadvertente6travasation of lipid-soluble agents .

%ialography is indicated for the evaluation of chronic inammatory

diseases and ductal pathoses. (ontraindications include acute

infection, 3nown sensitivity to iodine-containing compounds,and immediately anticipated thyroid function tests.


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$ON=EN,IONA+SIA+O)RA(HY

$onven&ional sialogra%"y o# gland iaged i&" $B$, iaging ,"e

iages are rendered in la&eral :A;and a4ial :B ; vies


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Sialogra%"y

1ateral pro#ectionof the parotiddemonstratingopaci0 cation allthe wayto the terminal

ducts and acini. BAn&ero%os&erior%ro8e!&ion o# &"esae glanddeons&ra&ing

= parenchymalblushin > from


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Sialogra%"y

Sialogra o# Noral

S./andi/.lar )land,"is la&eralview demonstratesparenchymal blushing.ormal 0ne branching isvisible. 1ac3 ofparenchymal blushing atthe anteroinferior marginiscaused by radiographic


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$OM(-,ED ,OMO)RA(HY

() is useful in evaluating structures

in and ad#acent to salivary glands" itdisplays both soft and hard tissuesand minute di4erences in soft tissuedensities .

() is useful in assessing acuteinammatory processes andabscesses as well as cysts,

mucoceles, and neoplasia.


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$OM(-,ED,OMO)RA(HY

•$, Iages i&" So#&,iss.e Algori&" A A4ialviedemonstrating bilateralenlargement of the parotidglands +arrowheads,.B $oronal vie o# &"esae %a&ien& ,"e!lini!al>"is&o%a&"ologi! diagnosis was

•autoimmune parotitis.


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(one beam computed tomographicimaging +(&()

Advantage$-(&() imaging is useful in evaluating

structure in and ad#acent to salivary gland

8se as record modality for conventionalsialogrphy

'roviding BD visuali5ation of ductal structure

Disadvantage $-(annot resolve di4erence in soft tissue

densitis


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(&() imaging of submandibular sialolith . (oronal +A,a6ial +& ,and BD rendition +c


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ultidetector computedtomographic imaging +D()

• Advantages $-

• It’s use in evaluating structure in and ad#acent tosalivary gland

• Display both soft and hard tissue

• )he parotid glang is moe radiopaque than thesurrounded fat but less than ad#acent muscles

• It’s useful in assessing acute inammatoryprocess

• Disadvantage $-

• Isn’t recogni5ed as sensitive study for salivarytumor .


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ultidetector computed

tomographic imaging


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MA)NE,I$ RESONAN$EIMA)IN)

CI for soft tissue mass details andlocali5ation

Di4eranciates $

%oft tissue vs. hard tissueormal vs. abnormal tissue

Identi0es facial nerve + parotid

(ontraindications$-9 -pacema3er


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magnetic resonance images reveal alymphoepithelial cyst involving the right

parotid gland.

)his a6ial )9-

weighted imagereveals a well-de0ned circular lesioninvolving the rightparotid gland with aninternal signalisointense to muscle.


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magnetic resonance images reveala lymphoepithelial cyst involving

the right parotid gland.

And thematching )


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MEDI$INE (OSI,RONEMISSION $OM(-,ED

,OMO)RA(HY;

%elective up ta3e of techntium

Assesees silvary gland function +notanatomy

@6pel technetium after stimulations


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S!in&igra%"y

S!in&igra%"y A 99 ,!*%er&e!"ne&a&escan of the salivary glands +right and left

anterioroblique views demonstrates increasedupta3e of radioisotope in the right parotid gland+blac3 arrowhead,. B1 S!in&igra &a?en a#&er

adinis&ra&ion of a sialogog +lemon #uice demonstratesretention of isotope in right parotid gland+white arrowheads,. )his is a typical presentationof salivary

stasis, ?arthin tumor, or oncocytoma.


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-+,RASONO)RA(HY

2or super0cial , soft tissue swilling

Di4erentioates cystic vs. solid

8s-guide 2A

also be helpful in detecting sialolithsand diagnosing advancedautoimmune

lesions +%# gren syndrome.


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A(HY -l&rasonogra%"y:-S; Iage o#Rig"& (aro&id)land Awell-

delineated solidmass is suggestedby echo returns

within the


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,HAN@ YO-

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Salivary Gland Radiology Presentation