WIDI - CA0372-Parotid Obstructive Sialadenitis, CT

Parotid Obstructive Sialadenitis, CT

Claim CME Credit

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.

CA0372-Parotid Obstructive Sialadenitis, CT

History

55-year old female in the emergency room with facial swelling on the right. Possible dental infection or parotiditis.

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 and shows abnormal, increased enhancement. The right main parotid duct is slightly dilated where it curves around the massacre muscle and the intraglandular ducts are not dilated; however, there is an 1-2mm mm stone in the proximal segment of the right parotid duct, best seen on image 137, series 4. There is no developing abscess within the parotid gland.

There is related cellulitis within the fat surrounding the parotid gland with thickening and infiltration of the overlying SMAS. The peri- parotid edema extends to the right submandibular space and the upper deep neck and to a lesser degree in the masticator space and minimally in parapharyngeal space.

The left parotid gland is normal.

Submandibular and sublingual glands

The submandibular and sublingual glands are normal so that the changes in the right plan do not appear to be related to autoimmune related sialoadenitis. The minimal dilatation of the submandibular intraglandular ducts is likely a normal variation.

The periparotid edema does extend to the right submandibular region, as described above.

Other findings

There are unrelated changes related to a temporal lobe resection.

Impression

Right parotid obstructive sialoadenitis without complications as described above rather than dental or other inflammatory conditions as an explanation for the patient’s symptoms and physical findings.

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.

Acuity

Routine: routine communication