Bilateral parotid involvement in Sjogren disease

Case contributed by Medical Doctor Oscar Vila

Presentation

Fluctuating focal swelling of right parotid region in patient with Sjogren disease.

Patient Data

Age: 55 years
Gender: Male

Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

MIP axial projection showing multiple hyperdense dotted foci inside both parotid glands, reflecting calcifications. No significant gland enlargement.

Inhomogeneous enhancement of both parotid glands. Small hypoattenuating foci in right parotid, probably a cyst, without defined solid focal lesions.

Case Discussion

The imaging appearance of the parotid glands in Sjogren disease depends on the stage of the disease.

In the early stages, the parotid glands may appear normal. Multiple small cysts in both parotids can be seen in the intermediate form of the disease. Late-stage Sjogren disease of the parotids involves large cystic and solid masses. The cystic components represent areas of destroyed gland or collections of saliva while the solid masses represent lymphoid aggregates which actively destroy the gland.

Contrast-enhanced CT typically demonstrates bilateral parotid enlargement, heterogeneous enhancement of solid and mixed cystic lesions and punctate calcifications.

MR sialography is the best imaging test if Sjogren disease is suspected because of its ability to accurately stage the severity of the disease.

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