WIDI - CA0371-Generalized Probably Viral Sialadenitis, CT

Generalized Probably Viral Sialadenitis, CT

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0.5 CME Credit available on completion

POINT OF CARE INFORMATION

This CME activity consists of the student reviewing the video of the professor reviewing the case as well as the associated DICOM image set related to the case in question.

Learning Objectives

As a result of participation in this activity, participants should be able to:

Provide improved patient care.
Greater knowledge of the imaging characteristics of the patient's disease.
Understand a better approach to interpretation of studies.

Faculty Disclosure

Mehmet Albayram, MD, Ivan Davis, MD, Mariam Hanna, MD, Anthony Mancuso, MD, Ronald Quisling, MD, Dhanashree Rajderkar, MD, Priya Sharma, MD, Roberta Slater, MD and Joann Stamm, MBA have disclosed that they have no relevant financial relationships. No one else is a position to control content have any financial relationship to disclose.

CME Advisory Committee Disclosure:

Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/.

Continuing Medical Education Credit

Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CA0371-Generalized Probably Viral Sialadenitis, CT

History

29 year old female in the emergency room with severe facial swelling with question of facial and/or neck abscess or uncertain etiology. Possible dental or salivary gland infection.

Exam

Contrast-enhanced CT of the maxillofacial region and neck and related anatomy with images obtained in the balanced or venous vascular phase to ensure optimal visualization of both arterial and venous structures as well as possible reactive changes around infected collections. 0.5-3.0 mm thick sections were obtained in the axial plane and reformatted 3D and/or in the coronal and sagittal planes and viewed inter actively in 3 dimensions at the computer work station.

Prior Study

None

Findings

Parotid Glands

The right parotid gland is enlarged, with markedly abnormal enhancement. The left parotid gland is possibly abnormally swollen with borderline abnormal increased enhancement. There is extensive intraglandular parenchymal edema but no discrete fluid collections.

The parotid ducts and the intraglandular ducts are not dilated without evidence of intraductal stones other causes of obstruction.

There is extensive cellulitis within the fat surrounding the right parotid gland, extending to the adjacent masticator, parapharyngeal and submandibular spaces with thickening and infiltration of the SMAS.

Submandibular glands

The submandibular glands are also both enlarged and show abnormal enhancement. There is substantial parenchymal edema within both submandibular glands with no discrete fluid collections in the gland parenchyma. The submandibular ducts and the intraglandular ducts are not dilated and show no intraductal stones other causes of obstruction.

There is cellulitis within the submandibular space, more prominent on the right than left, extending into the neck and submental region. The overlying SMAS is thickened.

The lymph nodes in level 1A and 1B are reactive in nature.

Sublingual glands

The sublingual glands are not enlarged and do not show abnormal enhancement

Other findings

The lacrimal glands and both globes are normal.

Other significant abnormal findings are not present.

Impression

Generalized, severe but otherwise uncomplicated sialoadenitis as described above, likely viral in nature.

Recommendations

The emergency medical service was notified of these findings within the routine context of emergency room care. They contacted the otolaryngology service for further referral rather than the oral maxillary facial service.