Figure 1
Control - lateral view
Lateral control film shows a radio-opaque submandibular duct calculus.
Submandibular calculus on conventional sialography
SectionHead & neck imaging
Case TypeClinical Cases
AuthorsD.V.Thomas, A.P.Wolinski
Connected authors
56 years, male
Clinical History
The patient presented with pain and tenderness of the right submandibular area following meals.
Imaging Findings
The patient presented with pain and tenderness of the right submandibular area following meals. A conventional submandibular sialogram was performed. The lateral oblique control film showed a calculus in the proximal main duct. Following injection of contrast medium (Omnipaque 300), this was seen as a filling defect within the duct with some proximal dilatation of the duct system. Following sialogogue stimulation, there was incomplete emptying of the duct system and the calculus persisted as a filling defect.
Discussion
Salivary calculi are commonly responsible for salivary gland disorders. They are much more common in the submandibular glands (83%) than in the parotids (10%) or other minor glands. The aetiology is poorly understood. Dehydration, febrile illness, stricture in the duct, small foreign bodies entering the salivary duct and associations with diabetes and hypertension have all been quoted in the literature.
Most calculi present with obstructive symptoms of painful swelling and tenderness during or following meals, and often this is reproduced on conventional sialography. Bimanual palpation may help to locate the calculus. Most submandibular calculi (80%) are radio-opaque, while most parotid calculi are radio-lucent. Plain films, particularly intra-oral and lateral oblique views, are useful to demonstrate the calculi. Conventional sialography is done with instillation of non-ionic contrast medium via the duct opening and completed with post-sialogogue images.
Ultrasound scanning, computed tomography, magnetic resonance imaging and endoscopy are other modalities that have been tried, often with good results. Various treatment options are available, namely intra-oral removal, gland excision, endoscopic removal, wire basket removal, extracorporeal shock wave lithotripsy and laser therapy.
Differential Diagnosis List
Submandibular duct calculus
Final Diagnosis
Submandibular duct calculus
References
[1]
Bull PD.
Salivary gland stones: diagnosis and treatment.
Hosp Med. 2001 Jul;62(7):396-9. (PMID: 11480125)
[2]
Jager L, Menauer F, Holzknecht N, Scholz V, Grevers G, Reiser M.
Sialolithiasis: MR sialography of the submandibular duct - an alternative to conventional sialography and US?
Radiology. 2000 Sep;216(3):665-71. (PMID: 10966693)
[3]
Heverhagen JT, Kalinowski M, Rehberg E, Klose KJ, Wagner HJ.
Prospective comparison of magnetic resonance sialography and digital subtraction sialography.
J Magn Reson Imaging. 2000 May;11(5):518-24. (PMID: 10813861)
[4]
Drage NA, Brown JE, Escudier MP, McGurk M.
Interventional radiology in the removal of salivary calculi.
Radiology. 2000 Jan;214(1):139-42. (PMID: 10644113)
Case information
| URL: | https://www.eurorad.org/case/1446 |
| DOI: | 10.1594/EURORAD/CASE.1446 |
| ISSN: | 1563-4086 |
Figure 2
Submandibular sialogram - lateral view
Right submandibular sialogram shows a larger filling defect in the main duct with mild dilatation of the intra-glandular duct system.
Figure 3
Submandibular sialogram - frontal view
Right submandibular sialogram shows a larger filling defect in the main duct with mild dilatation of the intra-glandular duct system.
Figure 4
Post-sialogogue lateral oblique view
Post-sialogogue, the duct system shows incomplete emptying with the filling defect in the duct still visible.
Figure 5
Post-sialogogue lateral view
Post-sialogogue, the duct system shows incomplete emptying with the filling defect in the duct still visible.
Control - lateral view
Lateral control film shows a radio-opaque submandibular duct calculus.
Submandibular sialogram - lateral view
Right submandibular sialogram shows a larger filling defect in the main duct with mild dilatation of the intra-glandular duct system.
Submandibular sialogram - frontal view
Right submandibular sialogram shows a larger filling defect in the main duct with mild dilatation of the intra-glandular duct system.
Post-sialogogue lateral oblique view
Post-sialogogue, the duct system shows incomplete emptying with the filling defect in the duct still visible.
Post-sialogogue lateral view
Post-sialogogue, the duct system shows incomplete emptying with the filling defect in the duct still visible.