Diagnosis of Heerfordt's syndrome by state-of-the-art ultrasound in combination with parotid biopsy: a case report

Abstract

The parotid gland is rarely affected by sarcoidosis (6% of all cases). If there is initial parotitis, and other major symptoms include fever, uveitis, or facial paralysis, the condition is referred to as Heerfordt's syndrome. The case presented here describes the diagnostic work-up and differentiation of swelling of the parotid gland by employing state-of-the-art ultrasound techniques in a 33-year-old patient with Heerfordt's syndrome. Color-coded duplex ultrasound demonstrated hypervascularization. Tissue harmonic and photopic imaging ultrasound additionally depicted hypoechoic, septated structural lesions of the glandular parenchyma with an optimized contrast. Since such structural changes are not a specific sonographic criterion for sarcoidosis, ultrasound-guided biopsy was performed for further clarification of the etiology of parotitis and for excluding lymphoma. In conclusion, state-of-the-art ultrasound with the option of obtaining a biopsy at low risk is a useful procedure for diagnosing unclear pathology of the parotid gland with rapid histological confirmation.

Parotid gland involvement in sarcoidosis: Sonographic features

“…A few case reports have described the sonographic appearance of parotid gland involvement in sarcoidosis (also known as Heerfordt's disease) as consisting typically in multiple, rounded hypoechoic and hypervascular areas scattered throughout the entire heterogeneous parenchyma. [6][7][8] In our series, however, only part of the gland could be affected, and even an isolated involvement of an intraparotid lymph node was seen. Our cases revealed no typical or uniform US appearance concerning echogenicity, echotexture, or vascularity.…”

Parotid tumors: MR imaging with pathological correlation

“…Fischer et al [20] reported that ultrasound and biopsy are useful procedures for the differentiation. …”

Ultrasound Characterization of Salivary Lesions

“…20 US features of granulomatous sialadenitis are nonspecific: single or multiple hypoechoic areas in an enlarged or normally sized gland or diffuse hypoechoic areas are noted. 9,12,19,[40][41][42][43] Mycobacterial disease of major salivary glands may manifest as a salivary gland mass, clinically indistinguishable from a neoplasm. 44 In the parenchymal type of tuberculosis, Chou et al 45 described focal, intraparotid, anechoic areas that might have a cavity or cavities within them.…”