Head and Neck Imaging

Sialadenitis

inflammation of a salivary gland.

Acute inflammation

This is commonly caused by sialolithiasis or a viral or bacterial infection. The most common viral infection is mumps. An acute bacterial infection usually occurs in dehydrated patients, often with poor oral hygiene. Acute suppurative sialadenitis is seen after major surgery, and also occurs in (usually premature) neonates.

CT or MRI show an enlarged gland, with increased contrast uptake; Stensens duct may appear dilatated, with thickened and enhancing walls, due to sialodochitis. CT may reveal sialolithiasis. Bacterial sialadenitis may lead to an intraglandular abscess (Fig.1).

Chronic inflammation

  • obstructive disease

    Strictures and/or sialolithiasis within Whartons duct or Stensens duct may result in chronic salivary gland infection. This may lead to destruction of the glandular acini. Sialography shows the combination of ductal stricture(s) with dilatated ductal portions (Fig.2). The affected gland appears enlarged on CT or MRI, with increased contrast enhancement. Retro-obstructive sialadenitis may occur through tumoral obstruction of the duct (Wharton's duct (VI:2), Fig. 1)

  • Non-obstructive disease

    - auto-immune disease: see Sjogrens syndrome, recurrent parotitis of childhood

    - postirradiation sialadenitis: the salivary glands show an increased uptake of contrast agent on CT and MR studies (radiation therapy, tissue changes (VI:2), Fig. 1). After some time, atrophy of the glands may be seen.

    - granulomatous (infectious) disease: sarcoidosis, tuberculosis head and neck, syphilis, cat scratch fever, toxoplasmosis, actinomycosis cervicofacial manifestation.

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    Fig.2

    Parotid sialography in a patient with chronic, recurrent parotid swelling. Ectasia of the parotid gland ducts is seen, with several filling defects caused by sialolithiasis. The peripheral ductal branches are poorly visualized. Chronic sialadenitis (courtesy by Luc Vanstraelen, MD, Mol, Belgium).
    Sialadenitis, Fig.1 (a)
    Sialadenitis, Fig.1 (b)
    Sialadenitis, Fig.2