British Journal of Radiology (2005) 78, 164-165
© 2005 British Institute of Radiology
doi: 10.1259/bjr/96432211
Ultrasound findings of iodide mumps
S J Park, MD, PhD1,
H S Hong, MD1,
H K Lee, MD1,
J H Joh, MD1,
J G Cha, MD1 and
H C Kim, MD2
1 Department of Radiology, Soonchunhyang University Bucheon Hospital, 1174, Jung-dong, Wonmi-gu, Bucheon-shi Gyeonggi-do, 420-021 and 2 Department of Diagnostic Radiology, Soonchunhyang University, Cheonan Hospital, 23-20, Bongmyungdong, Cheonan, Choongnam 330-721, Republic of Korea
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Abstract
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Iodide mumps, swelling of salivary glands after contrast medium injection, is a rare adverse reaction. We present a case in a 73-year-old man with advanced gastric cancer. About 10 min after a CT scan performed with intravenous injection of 140 ml of the low osmolality contrast agent Ioxaglate (Hexabrix 320, Guerbet, France), he complained of progressive swelling of the submandibular area. Ultrasound showed diffuse swelling and internal low echoic thick septa in the submandibular glands bilaterally. Approximately 1 h afterwards, the swelling of his submandibular glands started to regress and returned to normal within a day.
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Introduction
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Iodide mumps, swelling of salivary glands after contrast medium injection, is a rare adverse reaction [1]. The cause remains unclear, but the reaction seems to be idiosyncratic or related to toxic accumulation of iodide in the ductal system of the salivary glands [2]. Even though non-ionic contrast agents result in fewer adverse reactions than ionic contrast agents, iodide mumps may result from any iodinated contrast agent [1]. To our knowledge, reports of ultrasound findings of iodide mumps have been rare in English literature.
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Case report
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A 73-year-old man with advanced gastric cancer was referred for CT staging. The patient had no past history of allergy and had previously never received iodinated compounds. CT was performed after intravenous injection of 140 ml of the low osmolality contrast agent Ioxaglate (Hexabrix 320, Guerbet, France). Within 10 min of the CT scan, he complained of progressive swelling of the submandibular area. Physical examination revealed bilateral tender swelling of his submandibular glands. Ultrasound of the neck was performed with a GE LOGIQ 700MR ultrasound system with 7–10 MHz linear array transducer (GE Medical System, Wisconsin). Greyscale ultrasound showed diffuse bilateral swelling of his submandibular glands and internal low echoic thick septa. Colour Doppler ultrasound showed no significant increase of vascular flow in the swollen glands (Figure 1
). The parotid and thyroid glands were not swollen. Approximately 1 h after contrast medium administration, the swelling of his submandibular glands started to regress and returned to normal size within a day.
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Figure 1. A 73-year-old man with advanced gastric cancer. (a, b) Greyscale ultrasound images show diffuse swelling of right and left submandibular glands with internal septal thickening. (c) Colour Doppler ultrasound shows no significant increase of vascular flow in the swollen gland.
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Discussion
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Iodide mumps is referred to as abnormal swelling of the salivary glands associated with intravascular administration of iodine containing contrast material. This reaction is rare. Use of low-osmolality agents reduces the incidence of adverse reactions, but the incidence of iodism, including iodide mumps, is the same for low and high osmolar contrast agents [1]. The high concentration of iodide appears to induce inflammation of the salivary glands in the form of oedematous swelling of the mucosa. It leads to ductal obstruction with consequent inflammatory swelling of the salivary glands [2–4]. 98% of injected iodide is eliminated by the kidneys and only 2% is excreted from other organs, such as salivary, sweat and lacrimal glands. In normal subjects, the injected dose of contrast medium does not usually reach a sufficiently high iodide concentration to cause iodide mumps [4]. Impaired renal excretion of contrast material results in in vivo liberation of iodide and enables the salivary glands to concentrate inorganic iodide [4]. The prognosis of iodide mumps is relatively benign. The onset varies from within a few minutes to up to 5 days after contrast medium administration [2]. Associated adverse reactions with iodide mumps are facial nerve paralysis, severe allergic vasculitis, skin erythema, enlargement of the thyroid and lacrimal glands. However, no life threatening reaction has been reported [2]. The current management of iodide mumps is supportive therapy using analgesics and dialysis [5]. In almost half of reported cases recovery occurred without treatment [2]. In our case, swelling of the submandibular glands started to regress approximately 1 h after contrast medium injection, and returned to normal size within a day. Subsequent episodes of iodide mumps following repeated exposure to contrast media have also been observed [2]. To our knowledge, this is the first reported case in the English language literature of the ultrasound findings of iodide mumps. In our case, ultrasound findings of iodide mumps were diffuse swelling with prominent internal low echoic septa in the submandibular glands bilaterally without increase in vascularity. Although iodide mumps is a rare adverse reaction to the administration of iodine containing contrast material, knowledge of the entity and ultrasound findings should facilitate the diagnosis in patients with neck swelling after administration of iodine containing contrast material.
Received for publication June 14, 2004.
Revision received September 17, 2004.
Accepted for publication October 26, 2004.
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References
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- Berman HL, Delaney V. Iodide mumps due to low-osmolality contrast material. AJR Am J Roentgenol 1992;159:1099–100.[Free Full Text]
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- Kohri K, Miyoshi S, Nagahara A, Ohtani M. Bilateral parotid enlargement ("Iodide mumps") following excretory urography. Radiology 1977;122:654.[Abstract]
- Kalaria VG, Porsche R, Ong LS. Iodide mumps: acute sialadenitis after contrast administration for angioplasty. Circulation 2001;104:2384.[Free Full Text]
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Abstract
Introduction
