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return to: Salivary Ultrasound

see also: I131 sialadenitis (Radioiodine Sialadenitis)

Sample Procedure Note

Procedure: Diagnostic ultrasound of the salivary glands and upper neck

Preop Diagnosis: Status post I-131 therapy with left parotid swelling

Postop Diagnosis: Same; left parotid sialadenitis

Surgeon: Hoffman

Assistant: xxxxxxxxxx

Anesthesia: None

Description of Procedure: Following identification the patient informed consent and a brief timeout the Toshiba Aplio 500 ultrasound unit employing the 14-5 MHz probe was used to image:

The upper anterior neck showing unremarkable anterior bellies of digastric muscles, mylohyoid, geniohyoid and sublingual glands

The right submandibular gland was seen to be hyperechoic measuring 17.6 x 29.4 x 32.5 mm with a homogeneous character to it

The right parotid gland was identified as hyperechoic and homogeneous with a benign-appearing 7.2 mm lymph node (with a vascular hilum) located in the tail of the parotid gland adjacent to the external carotid both transverse and longitudinal images were identified showing an accessory lobe with slight heterogeneity to the tail of the parotid

The left submandibular gland was hyperechoic and homogeneous in character measuring 24.9 x 17.7 x 29.5 mm

The left parotid gland showed more heterogeneity in its mid and posterior aspect than the right parotid but overall was mildly hyperechoic with the greatest degree of heterogeneity identified in the tail. Longitudinal evaluation identified a benign-appearing lymph node measuring 8.5 mm in the superficial lobe and the aforementioned heterogeneity further documented with an inclusive view allowing for view of both the left submandibular and the left parotid showing a difference in echogenicity with the parotid hypoechogenic relative to the submandibular gland as well as heterogeneity with greater variability in hypoechoic structures in the tail of the left parotid. In contrast, the right submandibular gland and the parotid gland appeared similar in a normal hyper-echoic and homogeneous nature.

Additional image below identifying transvers assessement of the left submandibular gland (A,B) and longitudinal assessment (C,D)

References

Hoffman HT, Pagedar NA. Ultrasound-Guided Salivary Gland Techniques and Interpretations. Atlas Oral Maxillofac Surg Clin North Am. 2018 Sep;26(2):119-132. doi: 10.1016/j.cxom.2018.04.001. PMID: 30077320.