Non-ionic iodinated contrast-induced sialadenitis with parotid gland sparing in patient of hepatocellular carcinoma

Abstract

61-years-old male patient presented with complain of neck swelling and soreness following contrast-enhanced (CE) CT examination with resolution of symptoms in 36-48 hours. He is diagnosed with hepatitis C virus and hepatocellular carcinoma (HCC); already treated with radiofrequency ablation for HCC. He had already undergone two CECT examinations before he was referred to our institution for disease staging/treatment. He also underwent three triphasic CT scan examinations at our institution during the course of treatment for treatment response and staging. Patient remained undiagnosed up to his fourth CT scan due to inability to relate symptoms with contrast administration. The patient was offered close monitoring on fifth CT exam and ultrasound of neck revealed enlarged and echogenic bilateral submandibular glands, however, thyroid and bilateral parotid glands appear unremarkable. This represents transient iodinated contrast induced sialadenitis with sparing of parotid glands.

Characterization of Iodide-induced Sialadenitis: Meta-analysis of the Published Case Reports in the Medical Literature

“…The natural history of iodine mumps is benign and self-limited, which favors a conservative approach with observation, supportive therapy, and patient education (4,27). Based upon this collected cohort of case reports, clinicians faced with this entity often treat it as an immunologic response, administering steroids and/or antihistamines to combat the reaction.…”

“…All authors who reported kidney function categorized function as normal or impaired. 4 Renal function information was unavailable in eight cases.…”

“…A cute iodide sialadenitis, or "iodide mumps," is an adverse reaction to iodinated contrast causing salivary gland swelling minutes to days after iodine exposure (Fig 1) (1,2,15). Recovery time is variable, and the incidence of this acute inflammation is unknown (4). In one study of adverse reactions to intravascular contrast material in 337,647 patients, not a single case of iodide mumps was recorded (7).…”

“…A wide variety of methods have been used to treat iodide sialadenitis, including antihistamines, corticosteroids, hyperhydration, and dialysis in patients with renal failure, none of which have proven efficacy (3,4,19,28).…”

Iodide mumps: a rare complication of idione containing contrast after coronary angioplasty

“…This complication introduced painless swelling in bilateral or unilateral submandibular or sublingual glands (1,2). The true incidence of this adverse reaction remains unclear and some researchers believe that it may be underdiagnosed (3). However, a study has reported that the incidence is nearly 1%-2% (4).…”