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Clinical Problem Solving: Radiology
June 2012

Radiology Quiz Case 1: Diagnosis

Author Affiliations


Arch Otolaryngol Head Neck Surg. 2012;138(6):598. doi:10.1001/archotol.138.6.598

Sialography of the submandibular duct demonstrated findings consistent with 131I radiation damage to the submandibular gland. Although the dye injected during sialography did reach the affected submandibular gland (no strictures), subsequent imaging identified retained dye despite massage, and the use of lemon drops suggested damage to the acini. The findings of a review of the RAI nuclear medicine scans were also consistent with high uptake within the affected submandibular gland (Figure 1 and Figure 4). Options for intervention, including observation, steroid insufflation, sialendoscopy, and submandibular resection, were discussed. Sialoendoscopy and steroid insufflation were chosen. Sialendoscopy revealed no stones or direct areas of stricture in the left submandibular gland. Triamcinolone acetonide (30 mg in 3.0 mL) was then infused into the duct. The patient reported marked improvement, with only minimal swelling and tenderness, at her 3-month follow-up visit, directing her to request further steroid insufflation in clinic.

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