Contrast-Induced Sialadenitis: An Under-Recognized Adverse Reaction in Radiology and Clinical Practice.

Alena Khalil, Kevin J Abrams, Charif Sidani, Márcio Luís Duarte, Leonardo Furtado Freitas
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Abstract

Contrast-induced sialadenitis (CIS), a rare inflammatory reaction of the salivary glands, occurs after exposure to iodinated contrast media (ICM). This self-limiting condition typically manifests as glandular swelling and pain, with variable severity, from hours to days post-contrast administration. Its etiology includes inflammatory edema, ductal obstruction, and pseudoallergic or idiosyncratic reactions. Non-ionic, low-osmolar agents such as Iohexol and Iodixanol are frequently implicated. Risk factors include iodine allergy, renal dysfunction, and inadequate premedication. Diagnostic imaging via CT or ultrasound reveals characteristic findings such as glandular enlargement, periglandular fat stranding, and heterogeneous enhancement, aiding differentiation from other causes like infection or neoplasms. This case series presents three patients who developed sialadenitis following contrast-enhanced CT scans. Presentations ranged from mild, localized submandibular swelling to rapid-onset bilateral glandular inflammation involving the parotid and submandibular glands. All cases highlight the need for prompt recognition and adherence to preventive measures, including premedication with corticosteroids and hydration, especially in high-risk patients. Management is largely supportive, involving corticosteroids, antihistamines, and NSAIDs, with severe cases requiring closer monitoring. By raising awareness of this underreported condition, this article underscores the importance of early recognition and differentiation from other conditions by radiologists, emphasizing their role in timely diagnosis and management. It also calls for further research to optimize prevention and management strategies.

造影剂诱导的涎腺炎:放射学和临床实践中未被充分认识的不良反应。
造影剂诱导的涎腺炎(CIS)是一种罕见的唾液腺炎症反应,发生在暴露于碘造影剂(ICM)后。这种自限性疾病通常表现为腺体肿胀和疼痛,严重程度不同,在对比剂给药后数小时至数天。其病因包括炎性水肿、导管阻塞、假性过敏或特异性反应。非离子型、低渗透压剂,如碘己醇和碘二醇,经常涉及。危险因素包括碘过敏、肾功能不全和术前用药不足。CT或超声诊断影像显示特征性表现,如腺体肿大、腺周脂肪搁浅、异质性强化,有助于与其他原因(如感染或肿瘤)鉴别。本病例系列介绍了三例在CT增强扫描后出现涎腺炎的患者。表现范围从轻度,局部下颌骨肿胀到快速发作的双侧腺体炎症,包括腮腺和下颌骨腺。所有病例都强调需要及时认识和坚持预防措施,包括预先使用皮质类固醇和水合治疗,特别是在高危患者中。治疗主要是支持性的,包括皮质类固醇、抗组胺药和非甾体抗炎药,严重者需要更密切的监测。通过提高对这种被低估的疾病的认识,本文强调了放射科医生早期识别和区分其他疾病的重要性,强调了他们在及时诊断和管理中的作用。它还要求进一步研究以优化预防和管理战略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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