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下颌下腺炎(Submandibular sialadenitis)CT病例图片影像诊断分析

时间:2010-10-24  来源:ACR Thursday, November 12, 2009  作者:freemanpyw 【复制分享】【讨论-纠错】【举报

7YN影像园XCTMR.com

【诊断要点】7YN影像园XCTMR.com

  1. Acute sialadenitis may be secondary to a bacterial/viral infection or an obstructing lesion such as a calculus or tumor at the floor of the mouth. 急性下颌下腺炎可以继发于细菌/病毒感染,也可以由于结石或口腔底部肿瘤所致的梗阻性病变所引起。
  2. Associated conditions include HIV, sarcoidosis, Sjogren syndrome, dehydration, diabetes mellitus and immunocompromised/postoperative patients. 相关的病变包括HIV、结节病,干燥综合症,脱水、糖尿病和免疫抑制/术后患者。
  3. Imaging is often helpful to delineate the location of the calculus and the presence/absence of subsequent complications (abscess formation, osteomyelitis, etc).影像检查对于结石的定位以及是否有并发症有很大的帮助。

【讨论】: Inflammation of the submandibular gland accounts for approximately 10-15% of cases of sialadenitis involving any of the major salivary glands. Risk factors for submandibular sialadenitis include immunocompromised/postoperative patients, debilitation, elderly patients, dehydration, diabetes mellitus, hypothyroidism, hypercalcemia, radiation/chemotherapy, eating disorders (bulimia, anorexia nervosa), and other concomitant medical problems (malignancy, head and neck infections). Associated conditions also include HIV, sarcoidosis, Sjogren syndrome, tuberculosis, mumps, and cat scratch disease. It is rare in pediatric patients.在各种涎腺炎中,下颌下腺炎约占10-15%,下颌下腺炎的易感因素包括免疫抑制/术后患者、虚弱、老年患者、脱水、糖尿病、甲状腺功能减低,血钙过多、放化疗、饮食障碍(食欲亢进、神经性厌食症)以及其他伴发的医学疾患(恶性肿瘤、头颈部感染)。相关的病变也包括HIV,结节病,干燥综合症,结核、腮腺炎以及猫抓病,在儿童患者中少见。 7YN影像园XCTMR.com

    Most commonly, acute sialadenitis is a result of a bacterial infection (common organisms include Staphylococcus aureus, Streptococcus, Haemophilus influenzae, and Pseudomonas). Less commonly, the infection may be related to a virus such as mumps, coxsackie virus, herpes and influenza. On the other hand, chronic sialadenitis is usually a result of salivary stasis, ductal stenosis, calculi or other obstructive lesions such as a tumor at the floor of the mouth. Sialolithiasis is most common in the submandibular gland, accounting for approximately 80% of cases. The majority of calculi are radio-opaque, vary in size, and can be single or multiple. Often, the calculus obstructs a duct, resulting in secondary inflammation of the affected salivary gland which then becomes suppurative.通常最常见的原因是细菌性感染(包括金葡菌、链球菌、流感嗜血菌、假单胞菌属),相对不常见的是病毒感染(如流行性腮腺炎、柯萨奇病毒、疱疹及流感病毒)。另一方面,慢性涎腺炎通常是由于涎液排出受阻所致,导管狭窄、结石或其他梗阻性病变如口腔底部的肿瘤。涎石最常见于下颌下腺,约占全部涎石病的80%,大部分的结石是不透X射线的,大小不一,可以是单发或多发。结石常常阻塞导管导致继发的涎腺炎进而引起脓肿。7YN影像园XCTMR.com

    Although plain film radiography can depict the majority of calculi, CT is often first-line imaging. The affected submandibular gland is enlarged, hypervascular and there may be associated cellulitis/myositis. Calculi are easily identified and described as being either distal (towards the ductal opening) or proximal (towards the submandibular hilum). Chronic sialdenitis manifests as a small, fatty gland.虽然平片可以显示大多数的结石,但是常常首先行CT检查,受累的涎腺增大,血供丰富并且可以伴有蜂窝组织炎/肌炎。结石很容易被显示出来并且明确是位于末端(接近于导管口)或近端(接近于下颌下腺)。慢性的涎腺炎表现为小的、富脂性腺体7YN影像园XCTMR.com

     Complications of sialadenitis include abscess formation, bacteremia/septicemia, osteomyelitis, cranial nerve involvement (facial nerve paralysis), and respiratory complications. Management of acute sialadenitis includes both medical (conservative) and surgical options. Antibiotics, analgesics, sialogogues, warm compresses, glandular massage and intravenous fluids are the mainstay of medical management. Surgical options include duct cannulation with subsequent removal of the calculus and complete gland excision.涎腺炎的并发症包括脓肿形成,菌血症/败血症,骨髓炎,颅神经受累(面神经麻痹),以及呼吸系统并发症。急性的涎腺炎的治疗包括内科(保守治疗)和外科两种方式。抗菌素、镇痛剂、催涎剂,热敷,腺体按摩以及静脉补液是内科治疗的主要方式。外科治疗包括导管插入术并结石清除术及完全的腺体切除等。7YN影像园XCTMR.com

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