耳下腺唾影像知見補遺 : 炎症性疾患

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Sialography was employed in the study of 136 patients with inflammatory and similar diseases of the parotid gland, except for sialoangiectasis and systemic diseases, to evaluate it in the diagnosis and treatment of these diseases of the parotid gland. 1. In acute sialodochitis caused by a foreign body, there was evidence of leaks from the main duct, indicating the presence of abscesses in the surrounding of Stensen's duct. 2. In acute parotitis, morbid changes of duct system consisted of dilatation, stenosis, interruption and discontinuance of the branches, as well as leaks from them, and there was little change in the main duct. The shadow of the gland exhibited various morbid changes. The granular type (IV) and spotted type (VIII_1) shadows of the gland, which are characteristic appearances of the gland in this disease, were seen in rather small percentages of cases. Generally speaking, there was a correlation between the severity of clinical symptoms and the degree of sialographic changes. There were, however, sometimes discrepancies bitween clinical picture and sialographic changes. The shadow of the duct system returned to normal with time, while that of the gland was delayed in showing improvement. When morbid change of the gland was of high degree, it demonstrated a dappled type (III) shadow for a long time, indicating impairment of its functioning. When there was intensive destruction, the gland came to demonstrate an atrophic type or shrunken shadow (X). 3. Sialograms showed no trace of morbid changes after epidemic parotitis had been cured. 4. When there was an acute inflammation in the surrounding tissue, the gland was compressed. In some instances, the inflammation involved the gland, and there was evidence of what might be called partial parotitis. 5. Chronic sialodochitis was characterized by dilatation and irregularity of the walls of the main duct. The branches were sometimes involved, but the gland was seldom involved. 6. Sialographic study of chronic or recurrent swelling or inflammation of the parotid gland has revealed that it is an entity which is very complicated in etiology and pathology. 7. In spasms of the Stensen's duct caused by stimulation of the trigeminus, there were stenosis of the orifice of the main duct and dilatation of the duct system. 8. In glass-blowers' disease, sialograms showed dilatation of the duct system. 9. There were a group of patients with normal sialograms, in whom swelling of the parotid gland temporarily subsided following mastication. It would seem that abnormal secretion of saliva by the gland cells is responsible for the condition. 10. In swelling of the parotid gland caused by dysendocrisiasis or dystrophia, there was no marked deviation from normal, but in swelling of the parotid gland often seen in those who had been repatriated from Siberia, the gland was less dense than normal. This seems to indicate fatty degeneration caused by dystrophia. 11. In allergic inflammation of the gland, there was dilatation of the branches, and the gland was less dense than normal. 12. In inflammatory tumor in comparatively early stages, there were massive leakages of Moljodol in parts of the gland, with no marked changes in the duct system. In late stages, however, there was the evidence of a destruction of high degree both in the duct system and gland. 13. In some of those suffering from various forms of chronic inflammation mentioned above, there were morbid changes of high degree in the duct system, which were due to infection secondary to inflammation. 14. There were some cases of chronic parotitis with lesions localized to the accessory gland, and of partial parotitis associated with intraglandular lymphnoditis. 15. There were very few cases of chronic parotitis in the narrow sense of the term, i. e. the cases in which acute inflammation has passed into chronic condition. 16. In tuberculosis of the Stensen's duct, localized lymphogenic tuberculosis of the parotid gland and intraglandular lymphnoditis of tuberculous origin, sialograms showed a change characteristic of each disease: leaks from the main duct, intraglandular abscess, and defective shadow of the gland with the duct system showing abnormal pattern and destruction, respectively, were their chief changes. 17. In syphilitic parotitis in its second stage, there was no change in the duct system, while the gland was less dense than normal. 18. In chronic inflammation of the surrounding tissue, there scarcely was any case showing involvement of the gland by inflammation, though the gland was compressed as in acute inflammation. 19. In hypertrophy of the masseter, there were a characteristic abnormal run of the main duct and forward displacement of the gland. Sialography was shown to be of value in ascertaining the location, degree and character of the lesion. It is an important diagnostic aid and indispensable to planning a treatment for various inflammatory diseases of the parotid gland.
千葉大学の論文

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鴻重義
千葉大学医学部放射線医学

耳下腺唾影像知見補遺 : 炎症性疾患

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