Radiological Category Neuroradiology Principal Modality 1 CT Principal

Case History 53 year old male complaining of several months of neck swelling with

Test Your Diagnosis Which one of the following is your choice for the appropriate

Findings and Differentials Findings: Markedly enlarged, enhancing left submandibular gland with a large 1.

Discussion • Sialolithiasis occurs most commonly in the submandibular gland. This is thought to

Diagnosis Sialadenitis caused by sialolithiasis.

References • Grossman RI, Yousem DM, Extramucosal Diseases of the Head and Neck. In:

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Radiological Category: Neuroradiology Principal Modality (1): CT Principal Modality (2): None Case Report #0487 Submitted by: John S. Yoo, M. D. Faculty reviewer: Eliana Bonfante-Mejia, M. D. Date accepted: 14 March 2008

Case History 53 year old male complaining of several months of neck swelling with no relief after a course of antibiotics.

Radiological Presentations

Test Your Diagnosis Which one of the following is your choice for the appropriate diagnosis? After your selection, go to next page. • Sialosis • Sialadenitis with sialolithiasis • Enlarged necrotic lymph node • Kuttner tumor • Submandibular venous vascular malformation.

Findings and Differentials Findings: Markedly enlarged, enhancing left submandibular gland with a large 1. 1 cm stone in Wharton’s duct. Differentials: • Submandibular venous vascular malformation – lobulated, heterogenously enhancing mass. • Sialosis – painless bilateral enlargement of salivary glands, usually the parotid glands. Associated with diabetes, obesity, and alcoholism. • Kuttner tumor – pseudomass of salivary gland associated with calcification.

Discussion • Sialolithiasis occurs most commonly in the submandibular gland. This is thought to be due to a more viscous saliva and superior direction of travel for the secretions of the submandibular gland. • No exact mechanism formation has been elucidated. Possible factors are thought to include epithelial injury in the salivary gland duct, calcium salt precipitation, and salivary stasis. • Calculi are the most common cause of salivary gland inflammation. Additionally mumps, HIV, coxsackie are frequent etiologies. Poor dental hygiene may also contribute to infection. Microabscesses can sometimes develop.

Diagnosis Sialadenitis caused by sialolithiasis.

References • Grossman RI, Yousem DM, Extramucosal Diseases of the Head and Neck. In: Grossman RI, Yousem DM, ed. The Requisites: Neuroradiology. Philadelphia, Mosby, 2003: 700 -703.