Podcast
Questions and Answers
What is the primary purpose of Sialography?
What is the primary purpose of Sialography?
Which view is NOT utilized during Sialography for pre-imaging evaluation?
Which view is NOT utilized during Sialography for pre-imaging evaluation?
What is the first step in the Sialography technique?
What is the first step in the Sialography technique?
Which condition is NOT a contraindication for Sialography?
Which condition is NOT a contraindication for Sialography?
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What appearance is critical to understand for Sialographic interpretation?
What appearance is critical to understand for Sialographic interpretation?
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What is the strength of the common magnetic fields used in MRI for imaging?
What is the strength of the common magnetic fields used in MRI for imaging?
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What is the primary type of secretion produced by the Parotid Salivary Glands?
What is the primary type of secretion produced by the Parotid Salivary Glands?
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In T1-weighted MRI images, what is the normal signal intensity appearance of the parotid gland?
In T1-weighted MRI images, what is the normal signal intensity appearance of the parotid gland?
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Which duct is associated with the Submandibular Salivary Glands?
Which duct is associated with the Submandibular Salivary Glands?
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What is the normal appearance of the submandibular gland on T2-weighted MRI?
What is the normal appearance of the submandibular gland on T2-weighted MRI?
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How much of the total saliva is produced by the Submandibular Salivary Glands?
How much of the total saliva is produced by the Submandibular Salivary Glands?
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What imaging technique shows acid stimulation effects on saliva excretion in the mouth?
What imaging technique shows acid stimulation effects on saliva excretion in the mouth?
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Which imaging technique is most effective for visualizing soft tissue masses?
Which imaging technique is most effective for visualizing soft tissue masses?
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What percentage of total saliva do the Sublingual Salivary Glands constitute?
What percentage of total saliva do the Sublingual Salivary Glands constitute?
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Which of the following conditions would likely be indicated by a soft, painless swelling over the parotid area in a 12-year-old boy?
Which of the following conditions would likely be indicated by a soft, painless swelling over the parotid area in a 12-year-old boy?
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What does the presence of air in the parotid duct and gland indicate?
What does the presence of air in the parotid duct and gland indicate?
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Where do the minor salivary glands predominantly open?
Where do the minor salivary glands predominantly open?
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Which imaging technique is primarily used to illustrate stones and bone involvement in salivary gland diseases?
Which imaging technique is primarily used to illustrate stones and bone involvement in salivary gland diseases?
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How does the T2-weighted appearance of the normal parotid gland compare to the submandibular gland?
How does the T2-weighted appearance of the normal parotid gland compare to the submandibular gland?
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What feature is seen in the axial MRI of the parotid gland that indicates normal tissue?
What feature is seen in the axial MRI of the parotid gland that indicates normal tissue?
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What is the primary secretory type of the Submandibular Salivary Glands?
What is the primary secretory type of the Submandibular Salivary Glands?
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What appearance is described for duct dilations and constrictions in sialaduchitis?
What appearance is described for duct dilations and constrictions in sialaduchitis?
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Which autoimmune disease is characterized by xerophthalmia and xerostomia?
Which autoimmune disease is characterized by xerophthalmia and xerostomia?
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In which stage of autoimmune sialadenitis are punctate collections of contrast agents commonly observed?
In which stage of autoimmune sialadenitis are punctate collections of contrast agents commonly observed?
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What does the 'Mass in Hand Appearance' signify in sialography?
What does the 'Mass in Hand Appearance' signify in sialography?
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What does a sialogram reveal in a patient with 2º Sjögren's Syndrome?
What does a sialogram reveal in a patient with 2º Sjögren's Syndrome?
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How is 'sialectasia' characterized in the context of sialadenitis?
How is 'sialectasia' characterized in the context of sialadenitis?
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What percentage of glands shows destructive sialographic changes in advanced autoimmune sialadenitis?
What percentage of glands shows destructive sialographic changes in advanced autoimmune sialadenitis?
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What condition is categorized as benign lymphoepithelial lesions (BLEL)?
What condition is categorized as benign lymphoepithelial lesions (BLEL)?
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What is the normal size of the main duct in the parotid gland?
What is the normal size of the main duct in the parotid gland?
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Which phrase best describes the sialographic appearance of a normal submandibular duct?
Which phrase best describes the sialographic appearance of a normal submandibular duct?
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What condition is characterized by obstruction within the duct or gland due to a salivary calculus?
What condition is characterized by obstruction within the duct or gland due to a salivary calculus?
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Which condition is associated with dilation of salivary ducts?
Which condition is associated with dilation of salivary ducts?
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What is a common sialographic finding in patients with sialolithiasis?
What is a common sialographic finding in patients with sialolithiasis?
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What sialographic appearance is often associated with sialoadenitis?
What sialographic appearance is often associated with sialoadenitis?
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In which salivary gland duct is sialolithiasis most frequently observed?
In which salivary gland duct is sialolithiasis most frequently observed?
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What is the typical filling defect seen in sialolithiasis characterized by?
What is the typical filling defect seen in sialolithiasis characterized by?
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Which condition is characterized by rapid growth, facial paralysis, and a rock-hard texture in the gland?
Which condition is characterized by rapid growth, facial paralysis, and a rock-hard texture in the gland?
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What is the most common salivary gland tumor in infants and children?
What is the most common salivary gland tumor in infants and children?
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Which of the following statements about Pleomorphic Adenoma is true?
Which of the following statements about Pleomorphic Adenoma is true?
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Which mass suggests a benign nature if it is found superficial to the salivary gland?
Which mass suggests a benign nature if it is found superficial to the salivary gland?
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Which of the following is a characteristic of salivary gland tumors in the parotid?
Which of the following is a characteristic of salivary gland tumors in the parotid?
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What feature is indicative of Sjögren's syndrome?
What feature is indicative of Sjögren's syndrome?
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Which imaging technique is commonly used to identify pleomorphic adenoma?
Which imaging technique is commonly used to identify pleomorphic adenoma?
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Which condition is primarily associated with bilateral salivary gland enlargement?
Which condition is primarily associated with bilateral salivary gland enlargement?
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Study Notes
Salivary Glands
- Salivary glands are responsible for producing saliva
- The parotid gland is the largest major salivary gland.
- It is purely serous in nature.
- The parotid gland produces 30% of total saliva.
- Its main part is wedge-like, and it has a small deep part.
- The parotid (Stensen) duct is associated with the parotid gland.
Parotid Salivary Glands
- Lymphatic drainage begins within the parotid gland.
- Lymph then drains into preauricular or parotid lymph nodes.
- These nodes ultimately drain to the deep cervical chain.
Major Salivary Glands
- The parotid gland
- The submandibular gland
- The sublingual gland
Minor Salivary Glands
- Numerous, present in buccal, labial, palatal mucosa, tongue and floor of mouth.
- Mucous and secret continuously.
- Locations include palatine glands, sublingual glands, labial glands.
Submandibular Salivary Glands
- Mixed (mostly serous).
- Located between the mandible, mylohyoid muscle, and hyoid bone (occupying the submandibular fossa).
- Drains into the mouth via Wharton's duct.
- The duct has a forward and upward travel path.
- Produces 60% of saliva.
Sublingual Salivary Glands
- Under the tongue, below the floor.
- Produces 5% of saliva.
- Contains 10-20 small ducts; these open into the submandibular duct or directly into the floor directly.
Imaging of Salivary Glands
- Plain radiography is used to visualize stones and bone lesions.
- Sialography visualizes ductal structure, gland function, and obstructions.
- CT (computed tomography) assesses bone and soft tissue lesions.
- MRI (magnetic resonance imaging) is excellent for soft tissue masses.
- Scintigraphy (radioisotope imaging) assesses gland function.
- Ultra-sonography (US) is used to find soft tissues and vascular lesions.
Plain Radiography
- Illustrates sialoliths (stones).
- Shows bony involvement to rule out salivary gland diseases, and shows bony changes causing peri-auricular swelling.
Sialography
- Contrast agent introduced into the duct system.
- Scout view (PA or lateral oblique) determines exposure parameters, and is used to demonstrate radiopaque calculi and to detect extra-glandular and bone diseases.
- Materials needed for sialography include a lemon, contrast agent, a cannula, syringe, dilation, and wire.
Parotid Sialography
- Methods to perform sialography include orifice dilation, cannulation, media injection, lateral oblique, and PA views.
Sialography Technique
- Post-evacuation radiographs involve unstimulated and stimulated imaging.
Contraindications of Sialography
- Sensitivity to contrast agents.
- Acute sialadenitis.
- Obstruction in the distal 1/3 of duct.
Sialographic Interpretation
- Detailed knowledge of normal salivary gland radiographic appearance.
- Duct course and diameter, branching patterns, and uniform/gradual filling/emptying are analysed.
- Pathologic conditions are evaluated.
Normal Sialographic Appearance (Parotid)
- Main duct measures 1-2mm in diameter.
- Filling is uniform throughout the gland.
- Branching is gradual and in the style of a tree in winter.
Normal Sialographic Appearance (Submandibular)
- Main duct measures 3-4mm in diameter.
- Filling is uniform.
- Branching gradually, but is smaller than in the parotid.
- Shows a bush-like winter appearance.
Pathological Sialographic Appearance
- Sialolithiasis (salivary calculi) blockage in ducts or glands.
- Bacterial sialadenitis: acute or chronic bacterial infection of the terminal acini.
- Sialodochitis: inflammation in the duct system.
- Sialectasia: dilation of the salivary ducts.
- Sialosis (sialadenosis): non-neoplastic, non-inflammatory enlargement.
Sialographic Evidence of Salivary Gland Diseases
- Sialolithiasis: shows radiopaque or filling defects.
- Sialodochitis: shows segmental constriction and retained contrast agent.
- Sialadenitis: shows dilation of terminal ducts and retained contrast agent.
- Tumor: shows large filling defects, compression, or displacement.
Pathological Sialographic Appearance (detailed)
- Calculi (sialolithiasis) shows filling defects and ductal dilation.
- Retained contrast on emptying can also be seen in cases of sialolithiasis.
- The submandibular duct is commonly affected, and will show symptoms of sialolithiasis.
Submandibular Sialography
- Variations in methods include lateral views with subtraction, and lateral views of mandible.
Sialaduchitis
- Inflammation of the ductal system of SGs.
- Shows segmented sacculations and strictures of main duct (SAUSAGE appearance).
- Associated calculi or ductal stenosis may also be present
Sialectasia
- Seen by evaluating dilation of salivary ducts
Autoimmune Diseases
- Mikulicz's disease: bilateral hypertrophy of lacrimal and parotid salivary glands with no additional symptoms.
- Sjögren's syndrome: xerophthalmia (keratoconjunctivitis sicca), xerostomia (sicca syndrome) may be 1° or 2°; the latter occurs when associated with systemic CT disease such as Rheumatoid Arthritis, SLE, etc. benign lymphoepithelial lesions (BLELs) may form.
Sjögren's Syndrome
- Shows retention of contrast media inside gland indicating non-functioning gland
Autoimmune Sialadenitis
- Demonstrates punctate and spherical contrast agent collections that remain in gland after sialogogue.
- Later, larger pools of contrast (cavitary sialectases) will accumulate.
Mass Effect (Ball in Hand Appearance)
- Smoothly displaced duct around the mass (indicating mass in parotid gland).
- Sialography is of limited value in diagnosing intraglandular masses.
MRI
- Uses strong magnetic fields (typically 1.5 Tesla, converting 10,000 gauss). This is stronger than the Earth's magnetic field (0.5 Gauss).
Normal MRI Appearance (Parotid Gland)
- T1-weighted scans show intermediate-to-high signal intensity.
- T2-weighted scans show low-to-intermediate signal intensity.
Normal MRI Appearance (Submandibular Gland)
- T1-weighted scans show slightly lower signal intensity.
- T2-weighted scans show slightly higher signal intensity.
Coronal MRI
- Shows the nasopharynx, oropharynx, tongue, masseter, medial and lateral pterygoid muscles.
- It includes the mandibular ramus, parotid gland, and the submandibular gland.
Sagittal MRI
- Head of mandibular condyle and parotid gland can be seen in this view.
Axial MRI
- Mandibular condyle, maxillary sinus, external auditory canal, parotid gland, and external carotid artery can be observed in this view.
Cyst (Axial MRI)
- Images indicate the presence of cyst within a parotid area.
Axial CT
- Scans of parotid and submandibular glands show radiographic signs of pathologies.
Axial CT with Contrast
- Shows structures and anatomical features to help with diagnosis, such as mandible, sublingual gland, etc..
Parotid Hemangioma
- A hemangioma in the parotid gland can be observed radiographically.
Warthin's Tumor
- Axial and coronal sections show evidence of Warthin's tumor.
Pnuemo Parotid
- Images show air in the parotid duct and gland.
- Presence of air in ducts and gland.
Scintigraphy (Radioisotope Imaging)
- Assess saliva excretion, parotid gland, submandibular gland, and thyroid function.
- Measurements are taken at 0-5 min, 6-15 min, 16-20 min and 21-25 min; and acid (or stimulatory substances) are often involved and timed for these measurements.
Single-Photon Emission CT (SPECT)
- Images with CT, from 4 different views.
Ultrasound (US)
- Used to visually observe gland structure and tissues.
Inflammatory Salivary Gland Diseases
- Acute (e.g. Mumps)
- Chronic (e.g. Sjögren's syndrome)
- Sialolith, trauma, infection, space-occupying lesions
Non-inflammatory Salivary Gland Diseases
- Metabolic & secretory abnormalities
- Malnutrition
- Neurological disorders
Space-occupying masses
- Cysts
- Neoplastic: Benign and Malignant
DDx of SG tumor
- 80% of salivary gland tumors are in parotid. 70-80% in superficial lobe
- Most are benign or low-grade
- Incidence of benign SG tumors increases with gland size
- Pleomorphic adenoma accounts for 75% of SG tumors
- 80% of pleomorphic adenomas in the parotid, 4% in submand, 1% in sublingual and 10% in minor glands
- Hemangioma is most common during infancy and childhood.
Pleomorphic Adenoma
- Sharp, circumscribed, homogeneous, low-signal oval mass in posterior medial parotid gland in T1 weighted MRI axial view.
DDx of Enlargements in the Parotid Area (Unilateral)
- Bacterial sialadenitis
- Sialodochitis
- Cysts
- Benign neoplasms
- Malignant neoplasms
- Intraglandular lymph nodes
- Masseter muscle hypertrophy
- Lesions in adjacent osseous structures
DDx of Enlargements in the Parotid Area (Bilateral)
- Bacterial sialadenitis
- Viral sialadenitis (mumps)
- Autoimmune diseases (Sjögren's Synd., Mikulicz, BLELs)
- Warthin's tumor
- Alcoholic hypertrophy
- Medication-induced conditions (iodine, heavy metals)
- HIV-associated multicentric cysts
- Masseter muscle hyperplasia
- Accessory salivary glands
- TMJ-related lesions
- Radiation therapy
DDx of Enlargements in the Submandibular Area (Unilateral)
- Bacterial sialadenitis
- Sialodochitis
- Fibrosis
- Cysts
- Benign neoplasms
- Malignant neoplasms
- AV malformation
DDx of Enlargements in the Submandibular Area (Bilateral)
- Bacterial sialadenitis
- Autoimmune sialadenitis
- Lymphadenitis
- Brachial cleft cysts
- Submandibular space infection
Mumps
- Most common cause of acute painful parotid swelling in children.
- Caused by paromyxovirus.
- Flu-like symptoms followed by bilateral painful parotid swelling.
- Resolves spontaneously in 5-10 days.
- Can be unilateral in some cases.
- Sometimes affects submandibular glands.
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Description
Test your knowledge on Sialography and its relationship with salivary glands. This quiz covers techniques, imaging appearances, and gland functions specifically related to radiological assessment. Perfect for students and professionals in medical imaging and radiology.
