This Article Abstract Full Text Full Text (PDF) Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Alyas, F Articles by Howlett, D C Search for Related Content PubMed PubMed Citation Articles by Alyas, F Articles by Howlett, D C

Diseases of the submandibular gland as demonstrated using high resolution ultrasound

¹ Department of Radiology, ² Department of Maxillofacial Surgery, Eastbourne District General Hospital, Eastbourne, UK and ³ Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, Hong Kong

View larger version (143K): [in a new window]   Figure 1. Axial ultrasound through a normal right submandibular gland showing its relationship to adjacent structures. S, submandibular gland; M, mylohyoid muscle; H, hyoglossus muscle; White arrow, intraglandular duct; D, posterior belly of digastric muscle.

View larger version (131K): [in a new window]   Figure 2. Oblique axial ultrasound through a normal left submandibular gland demonstrating the normal Wharton's duct. Small white arrow, Wharton's duct; Large white arrow, mylohyoid muscle.

View larger version (124K): [in a new window]   Figure 3. Oblique axial ultrasound through a normal right submandibular gland demonstrating the position of the Küttner lymph node. P, parotid gland; White arrow, Küttner lymph node; R, retromandibular vein; S, submandibular gland.

View larger version (99K): [in a new window]   Figure 4. Ultrasound of left submandibular gland demonstrating intraglandular sialolithiasis. Note the two large hyperechoic calculi within the gland that cast acoustic shadows.

View larger version (142K): [in a new window]   Figure 5. Ultrasound demonstrating sialolithiasis with dilatation of Wharton's duct (small white arrows) secondary to a meatal stone (not shown, see text). There is a non-obstructing intraductal calculus within Wharton's duct casting an acoustic shadow (large white arrow), together with sludge. S, submandibular gland.

View larger version (124K): [in a new window]   Figure 6. Ultrasound demonstrating a submandibular abscess in a man who presented with an acutely painful and enlarged gland. There is an ill-defined intraglandular hypoechoic mass and adjacent enlarged reactive lymph node (white arrow). Under ultrasound guidance pus was aspirated and subsequent culture grew Staphylococcus aureus. S, submandibular gland.

View larger version (132K): [in a new window]   Figure 7. Ultrasound demonstrating intraglandular tuberculous abscess. There is a complex mass (callipers) in the submandibular gland with a central necrotic abscess cavity. Excision confirmed involvement of the gland with Mycobacterium tuberculosis.

View larger version (132K): [in a new window]   Figure 8. Ultrasound of left submandibular gland demonstrating chronic sialadenitis secondary to stone disease. S, atrophic, hypoechoic, irregular gland. Note the associated intraglandular calculus (callipers).

View larger version (119K): [in a new window]   Figure 9. Ultrasound of the right submandibular gland demonstrating a Küttner tumour. There is a well-defined, hypoechoic mass in the submandibular gland, which could be mistaken, clinically and sonographically for a tumour. Diagnosis of chronic inflammation was confirmed by core biopsy and subsequent excision.

View larger version (128K): [in a new window]   Figure 10. Ultrasound of the same patient as in Figure 9 demonstrating increased radial flow on Doppler examination within the lesion.

View larger version (143K): [in a new window]   Figure 11. Ultrasound of the left submandibular gland in a patient with suspected thoracic sarcoidosis and painless salivary gland enlargement. The submandibular gland is enlarged, heterogeneous in texture and hypoechoic. Subsequent glandular biopsy confirmed the presence of sarcoid granulomata.

View larger version (132K): [in a new window]   Figure 12. Submandibular ultrasound in a patient with Sjögren's syndrome. The gland is diffusely enlarged and of heterogeneous echotexture. Note the hypoechoic foci within the gland representing early sialectatic changes.

View larger version (121K): [in a new window]   Figure 13. Ultrasound of the lacrimal gland in a patient with Sjögren's syndrome. There are hypoechoic foci present within the enlarged gland (white arrow), which has a similar appearance to the submandibular gland in Figure 12.

View larger version (127K): [in a new window]   Figure 14. Ultrasound of the left submandibular gland demonstrating numerous prominent cystic spaces typical of florid sialectasis in Sjögren's syndrome. A similar appearance can occur in HIV infection.

View larger version (115K): [in a new window]   Figure 15. Ultrasound demonstrating submandibular gland pleomorphic adenoma. This lesion appears rounded, well defined and hypoechoic with distal acoustic enhancement present.

View larger version (149K): [in a new window]   Figure 16. Submandibular ultrasound demonstrating an oncocytoma confirmed on gland excision. It has a similar appearance to pleomorphic adenoma (see Figure 15).

View larger version (157K): [in a new window]   Figure 17. Submandibular ultrasound in a patient with an intraglandular adenoid cystic carcinoma. This appears as an ill-defined, hypoechoic and inhomogeneous mass.

View larger version (126K): [in a new window]   Figure 18. Submandibular ultrasound in a patient with mucoepidermoid carcinoma (large white arrow). Sonographically the features shown are similar to the adenoid cystic carcinoma in Figure 17. Note that in this case there is also extraglandular extension of tumour with invasion of the subcutaneous tissues and skin (small white arrows).

View larger version (127K): [in a new window]   Figure 19. Ultrasound demonstrating lymphoma of the submandibular gland confirmed with biopsy. There is a large, hypoechoic intraglandular mass. This patient had known disseminated B-cell lymphoma.