Image Case Report: 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, is a rheumatology fellow at Boston Medical Center.

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

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5. James-Goulbourne T, Murugesan V, Kissin EY, et al. Sonographic features of salivary glands in Sjögren’s syndrome and its mimics. Curr Rheumatol Rep. 2020 Jun 19;22(8):36.
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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.