Computed tomography and sialography of chronic pyogenic parotitis

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Abstract
Computed tomography (CT was performed immediately following, or simultaneous with, conventional sialography on a group of 45 patients with parotid gland swellings over a 2-yr period. Tumors occurred in 8 sarcoidosis in 22, actinomycosis in 2 and chronic pyogenic parotitis in 13 patients. In the latter group, there were 2 cases of bilateral disease, for a total of 15 glands. The sialographic and the combined CT-sialographic features were retrospectively analyzed. In all cases, ductal pathology was more severe in the main and proximal branches, was better demonstrated on conventional sialography and was diagnostic in 10/14 glands (71%). CT-sialography was the superior modality in the evaluation of the gland parenchyma and the adjacent structures demonstrating diagnostic features of infection in 8/14 glands (57%). However, a combination of both modalities presented a consistent pattern of infection in all cases, distinctive from tumors and sarcoidosis. CT-directed aspiration was peformed on the 4 glands which were equivocal on conventional sialography, and 2 of these underwent a simultaneous aspiration-irrigation with antibiotics. Although this report is based on a limited experience, CT-sialography with aspiration appears to be an interventional radiological alternative to the traditional diagnostic superficial parotidectomy. Ultrasonography (2 cases) and nuclear scintigraphy (1 case) added little useful information in chronic pyogenic parotitis.

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