A Sound Diagnosis for Glandular Swelling

In contrast, conditions that mainly affect the parotid glands and less frequently the submandibular glands include diabetes mellitus, MALT lymphoma or benign lymphoepithelial lesions in HIV. In diabetes mellitus, the parotid glands can appear hyperechogenic due to fatty infiltration and their size may correlate with HgbA1C levels.^1,8 In MALT lymphoma, the disease commonly affects the thyroid and salivary glands, especially the parotid glands. Sonographic findings include “linear echogenic strands pattern” or “multiple small hypoechoic nodules” (tortoiseshell/segmental pattern). In HIV-associated disease, parotid involvement is common, while submandibular glands are usually spared, appearing as larger but more focal cystic lesions with septation and producing through transmission.^1,5

Conclusion

Ultrasonography is valuable for diagnosing salivary gland diseases, aiding in the differentiation of primary Sjögren’s disease. When submandibular gland involvement with focal, nodular hypo­echoic lesions is present while sparing the parotid glands, IgG4-RD in the salivary glands should be considered.

Hung Vo, MD, was a rheumatology fellow at Boston Medical Center at the time this article was written.

Zhichun Lu, MD, is a pathologist at Boston Medical Center. She is an assistant professor at Chobanian & Avedisian School of Medicine at Boston University, in the Department of Pathology and Laboratory Medicine.

Eugene Kissin, MD, is a rheumatologist at Boston Medical Center. He is a clinical professor of medicine and the program director for the rheumatology fellowship program at Chobanian & Avedisian School of Medicine at Boston University.

References

1. Kissin EY, Sharp V. “Salivary Gland Ultrasound for Sjögren’s Syndrome.” Musculoskeletal Ultrasound in Rheumatology Review 2nd ed., edited by Minna J. Kohler, Springer, 2021.
2. Jousse-Joulin S, Gatineau F, Baldini C, et al. Weight of salivary gland ultrasonography compared to other items of the 2016 ACR/EULAR classification criteria for primary Sjögren’s syndrome. J Intern Med. 2020 Feb;287(2):180–188.
3. De Vita S, Lorenzon G, Rossi G, et al. Salivary gland echography in primary and secondary Sjögren’s syndrome. Clin Exp Rheumatol. 1992 Jul–Aug;10(4):351–356.
4. Cornec D, Jousse-Joulin S, Pers J-O, et al. Contribution of salivary gland ultrasonography to the diagnosis of Sjögren’s syndrome: Toward new diagnostic criteria? Arthritis Rheum. 2013 Jan;65(1):216–225.
5. James-Goulbourne T, Murugesan V, Kissin EY. Sonographic features of salivary glands in Sjögren’s syndrome and its mimics. Curr Rheumatol Rep. 2020 Jun 19;22(8):36.
6. Law ST, Jafarzadeh SR, Govender P, et al. Comparison of ultrasound features of major salivary glands in sarcoidosis, amyloidosis, and Sjögren’s syndrome. Arthritis Care Res (Hoboken). 2020 Oct;72(10):1466–1473.
7. Shimizu M, Okamura K, Kise Y, et al. Effectiveness of imaging modalities for screening IgG4-related dacryoadenitis and sialadenitis (Mikulicz’s disease) and for differentiating it from Sjögren’s syndrome (SS), with an emphasis on sonography. Arthritis Res Ther. 2015 Aug 23;17(1):223.
8. Gupta A, Ramachandra VK, Khan M, et al. A cross-sectional study on ultrasonographic measurements of parotid glands in type 2 diabetes mellitus. Int J Dent. 2021 Mar 2:2021:5583412.

Adapted from an article in the November 2023 issue of The Rheumatologist (Vol. 17, No. 11).