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A pathognomonic CT of the parotid gland
Received: 17 June 2014 Accepted: 6 October 2014 Disponible en ligne 30 October 2014
Available online at
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A pathognomonic CT of the parotid gland Un scanner parotidien pathognomonique F. Crampona, M. Eliezerb, O. Choussya, H. Hardya, O. Trosta,* a Department of oral and maxillofacial surgery and multidisciplinary federation of cervicomaxillofacial oncology, university hospital of Rouen, Charles-Nicolle hospital, 1, rue de Germont, 76031 Rouen, France b Department of radiology, university hospital of Rouen, Charles-Nicolle hospital, 1, rue de Germont, 76031 Rouen, France
Observation A 48-year-old female patient presented with a first episode of painful right preauricular swelling and fever. The ostium of the right parotid duct was normal and the saliva was clear. No other symptoms such as xerostomia or xerophtalmia were observed.
Computed tomography (CT) revealed a large abscess of the right parotid gland. No parotid stone was found. There were abnormal fat tissue deposition and diffuse punctiform calcifications in both parotid glands (fig. 1a and b). The bacterium Streptococcus intermedius was identified. This case of acute bacterial parotitis was successfully managed medically.
Figure 1. Computed tomography, horizontal (a) and frontal (b) sections showing a large abscess of the right parotid gland. No parotid stone was found. Abnormal fat tissue deposition and diffuse punctiform calcifications were present in both parotid glands.
* Corresponding author. e-mail: [email protected] (O. Trost).
What was probably the cause of this acute parotitis?
http://dx.doi.org/10.1016/j.revsto.2014.10.001 Rev Stomatol Chir Maxillofac Chir Orale 2014;116:e1-e2 2213-6533/ß 2014 Elsevier Masson SAS. All rights reserved.
e1
F. Crampon et al.
Rev Stomatol Chir Maxillofac Chir Orale 2015;116:e1-e2
Answer
Disclosure of interest
This first episode of acute parotitis suggested Sjo ¨gren’s syndrome: a complementary salivary gland biopsy and serologic analyses were performed since the CT-scan was pathognomonic. The serological analysis was positive for anti-extractable nuclear antigen and anti-Ro SS-A and LaSS-B antibodies. The histological study revealed a Chisholm and Mason grade IV lymphocytic sialadenitis, confirming the diagnosis. Sjo ¨gren’s syndrome is usually revealed by recurrent episodes of bilateral parotid swelling, with or without infection. Nevertheless, an early diagnosis may be made with typical CT-scan imaging [1].
The authors declare that they have no conflicts of interest concerning this article.
e2
Reference [1]
Sun Z, Zhang Z, Fu K, Zhao Y, Liu D, Ma X. Diagnostic accuracy of parotid CT for identifying Sjo ¨gren’s syndrome. Eur J Radiol 2012;81:2702–9.
Available online at
ScienceDirect www.sciencedirect.com
Images
A pathognomonic CT of the parotid gland Un scanner parotidien pathognomonique F. Crampona, M. Eliezerb, O. Choussya, H. Hardya, O. Trosta,* a Department of oral and maxillofacial surgery and multidisciplinary federation of cervicomaxillofacial oncology, university hospital of Rouen, Charles-Nicolle hospital, 1, rue de Germont, 76031 Rouen, France b Department of radiology, university hospital of Rouen, Charles-Nicolle hospital, 1, rue de Germont, 76031 Rouen, France
Observation A 48-year-old female patient presented with a first episode of painful right preauricular swelling and fever. The ostium of the right parotid duct was normal and the saliva was clear. No other symptoms such as xerostomia or xerophtalmia were observed.
Computed tomography (CT) revealed a large abscess of the right parotid gland. No parotid stone was found. There were abnormal fat tissue deposition and diffuse punctiform calcifications in both parotid glands (fig. 1a and b). The bacterium Streptococcus intermedius was identified. This case of acute bacterial parotitis was successfully managed medically.
Figure 1. Computed tomography, horizontal (a) and frontal (b) sections showing a large abscess of the right parotid gland. No parotid stone was found. Abnormal fat tissue deposition and diffuse punctiform calcifications were present in both parotid glands.
* Corresponding author. e-mail: [email protected] (O. Trost).
What was probably the cause of this acute parotitis?
http://dx.doi.org/10.1016/j.revsto.2014.10.001 Rev Stomatol Chir Maxillofac Chir Orale 2014;116:e1-e2 2213-6533/ß 2014 Elsevier Masson SAS. All rights reserved.
e1
F. Crampon et al.
Rev Stomatol Chir Maxillofac Chir Orale 2015;116:e1-e2
Answer
Disclosure of interest
This first episode of acute parotitis suggested Sjo ¨gren’s syndrome: a complementary salivary gland biopsy and serologic analyses were performed since the CT-scan was pathognomonic. The serological analysis was positive for anti-extractable nuclear antigen and anti-Ro SS-A and LaSS-B antibodies. The histological study revealed a Chisholm and Mason grade IV lymphocytic sialadenitis, confirming the diagnosis. Sjo ¨gren’s syndrome is usually revealed by recurrent episodes of bilateral parotid swelling, with or without infection. Nevertheless, an early diagnosis may be made with typical CT-scan imaging [1].
The authors declare that they have no conflicts of interest concerning this article.
e2
Reference [1]
Sun Z, Zhang Z, Fu K, Zhao Y, Liu D, Ma X. Diagnostic accuracy of parotid CT for identifying Sjo ¨gren’s syndrome. Eur J Radiol 2012;81:2702–9.