Ultrasound and Sialogram Correlates to Parotid Immunoglobulin G4-Related Disease

Abstract

Immunoglobulin G4 (IgG4)-related disease is an immune-mediated disorder that commonly manifests in the salivary glands. As a recently described disorder, the description and classification of IgG4-related disease is an ongoing process. Diagnosis of IgG4-related disease requires integration of clinical history, histopathology, and radiographic findings, including ultrasonography and sialography. In this case report, we correlate parotid ultrasonographic and sialographic findings in a patient with proven IgG4-related disorder confirmed from analysis of previous submandibular gland resections. We aim to highlight the utility of multimodality imaging in the diagnosis of IgG4-related disease.

Gadolinium as a contrast agent for infusion sialograms in patients with iodine allergy

“…Sialography remains an important tool in the diagnosis of salivary gland disease, further refined with introduction of the Iowa sialogram classification system to offer consistency in classifying pathology within parotid and submandibular ducts. 6,18,19 Contemporary high quality digital infusion sialography is primarily designed as a diagnostic tool to direct care but often provides ancillary benefit as a therapeutic measure in the course of duct dilation with irrigation. 5,9 Although adverse effects to iodinated contrast are rare during sialography, the standard precaution involving pretreatment with steroids and diphenhydramine may be either refused or not tolerated by patients.…”

“…Our review of the literature identified a single case‐study documenting the use of gadolinium as an alternative contrast for sialography in patients with iodine allergies 16 . We compared the use of gadolinium in a series of six sialograms with similar sialograms performed with traditional iodinated contrast agents, using the University of Iowa sialogram classification system as an objective reference, adapted previously from the Iowa parotid sialogram classification system 17–19 …”

“…16 We compared the use of gadolinium in a series of six sialograms with similar sialograms performed with traditional iodinated contrast agents, using the University of Iowa sialogram classification system as an objective reference, adapted previously from the Iowa parotid sialogram classification system. [17][18][19] 2 | METHODS…”