i i zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA EURO PEA N JO URNA L OF RADIO LO G Y European Journal of Radiology 17 (1993) 195-197 Extravasation of salivary secretions and mumps infection of the submandibular gland Guy Moulin* a, Philippe Andre”, Christophe Chagnaud”, Franqois Cheynet”, Jean-Robert Harleb, Jean-Michel Bartoli” zyxwvutsrqponmlkjihgfedcbaZYXWVUTS “Department of Radiology, ‘Department of Internal Medecine. ‘Depariment of Stomato/ogy and Oral Surgery, La Timone University Hospital, Boulevard Jean Moulin. 13385 Marseille Cude.x- 5. France (Received 12 May 1993; revision accepted 25 May 1993) Key words: Computed tomography; Salivary glands, CT; Salivary glands, abnormalities zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQP 1. Introduction Cervicothoracic edema is a rare but classical feature of mumps infection [l]. The present case shows that edema is due to salivary extravasation from the subman- dibular gland. 2. Case report A 37-year-old woman presented with bilateral swel- ling in the submental region associated with anterior cervical edema extending to the presternal level. The patient first noted swelling on the right side upon wak- ing in the morning 10 days prior to consultation. Swel- ling progressed rapidly to the left-hand side and cervicothoracic edema developed. The patient did not have fever. Her medical history was significant for Hashimoto’s thyroiditis that had been ongoing since 1985 and responded well to replacement therapy. Physical examination revealed a tender bilateral submental mass without cervical adenopathy. Neither keratoconjunctivitis sicca nor xerostomia were present. Palpation of the front side of the neck and manubrium revealed low-grade cervicothoracic edema involving a gel-like, resistant material. Palpation of the thyroid did not elicit pain. Laboratory findings did not indicate an inflammatory syndrome. Latex and Waaler-Rose tests were negative. * Corresponding author. Assays for circulating anti-DNA, antinuclear and anti- antigenic antibodies were negative. A biopsy sample from an accessory salivary gland in the floor of the mouth showed scarce inflammatory ductal-like components. This finding was not consistent with Sjogren’s syndrome secondary to Hashimoto’s thyroiditis. A CT-scan of the cervicothoracic region showed sub- cutaneous infiltration between the front edges of both sternocleidomastoideus muscles in the back and the superficial layer of the deep cervical fascia in the front. Proximally the edema surrounded the submandibulary gland on the right side (Fig. la). The right gland and interlobular lines were enlarged. Distally the edema extended into the fat layer of the upper part of the ante- rior mediastinum and subcutaneously in front of the manubrium (Fig. lb). Circulation in the superior vena cava was normal. These CT findings led us to suspect extravasation of salivary secretion, and sialography of the right subman- dibular gland followed by CT-scan was performed three days latter. Injection of contrast material into the gland did not produce a sensation of glandular fullness or cause pain. The Wharton canal and the intraglandular ducts appeared normal but an uneven distribution of the contrast material with a haloing aspect was observed in the upper pole and back of the gland. CT-scan depicted the presence of contrast media in the intraglandular lines and around the gland as well as infiltration to the sternocleidomastoideus muscle and along the vessels of 0720-048X/93/$06.00 0 1993 Elsevier Scientific Publishers Ireland Ltd. All rights reserved. ssDl0720-048x(93300431-w