Iodide Mumps After Trans-arterial Chemoembolization Procedure for Treatment of Hepatocellular Carcinoma: A Case Report

Case 277: Iodide Mumps

HistoryA 64-year-old woman with a medical history notable for hypertension, hyperlipidemia, cigarette smoking, type II diabetes mellitus, and end-stage renal disease requiring dialysis presented to the emergency department with tender swelling of her neck, which began 2 days prior to presentation.Four days prior to presentation, her dialysis catheter (Palindrome; Medtronic, Mannsfield, Mass) was partially pulled during dialysis. The next day, she underwent successful percutaneous transluminal balloon angioplasty with an iodinated contrast medium (20 mL Iopamiro; Bracco, Milano, Italy) via the existing right subclavian vein dialysis catheter because of stenosis in the superior vena cava. In addition, exchange of the dialysis catheter via guidewire was performed, without any reported complications. The following day, the patient underwent an uneventful scheduled hemodialysis treatment via the newly exchanged catheter.The patient denied trauma prior to the swelling. She had no known allergies, and prior exposure to iodinated contrast media on two occasions (2 months and 5 years before this presentation) was uneventful.Upon examination, the patient was fully alert and calm without any signs of distress and had bilateral submandibular firm nonpulsatile tender masses, each estimated at 3-4 cm in diameter.Because of a recent major vascular intervention, CT angiography of the neck was urgently performed.

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

PURPOSE

To evaluate the patient presentation of postcontrast sialadenitis and factors associated with its duration of symptoms through meta-analysis of case reports.

BACKGROUND

Acute iodide sialadenitis, or "iodide mumps," is a rare adverse reaction to iodinated contrast causing salivary gland swelling. The condition may be underdiagnosed, with researchers postulating that its true incidence may be close to 1-2%.

METHODS AND MATERIALS

This study was a meta-analysis performed using PRISMA Reporting Standards. A literature search with no language restriction was performed of the Medline database, primarily through PubMed, using keywords: "iodide mumps," "iodide sialadenitis," "sialadenitis," "salivary enlargement," "contrast reaction," "parotid swelling," and "submandibular swelling." Matching case reports and case series were reviewed, and data regarding the subjects' demographics, renal function, contrast administration, and symptoms were extracted. Uni- and multivariate linear regression analyses were applied to assess the predicting factors of a prolonged symptoms duration.

RESULTS

Sixty-five case reports and case series were identified, with 77 cases of iodide-induced sialadenitis. Two cases were unpublished and from the author's institution. Reported subjects' median age was 63 years, and 61% (47/77) were males. Median time to onset was 16 hours, and symptoms resolved in a median of 3 days after the initial onset. Twenty-seven subjects (35%, 27/77) were reported to have an impaired renal function at baseline. Administration of nonionic, low osmolarity contrast medium was reported most frequently (53%, 41/77). There was no difference in resolution of symptoms among subjects with impaired versus normal renal function. Symptoms were resolved in all cases over a median of 3 days with no statistically significant difference between those who received therapeutic intervention and those who did not (p = 0.430). Older age and longer time to onset were significantly associated with longer duration of symptoms in both uni- and multivariate linear regression models, and presence of tenderness demonstrated statistical significance associated with longer duration of symptoms in the univariate model.

CONCLUSION

Postcontrast sialadenitis is a rare reaction to iodinated contrast media. Older age and a longer time to onset of symptoms are associated with longer duration of symptoms.

Iodinated contrast-induced sialadenitis: a review of the literature and sonographic findings in a clinical case

Swelling of the salivary glands, also known as iodide or iodine mumps, is a rare adverse reaction to administration of iodine, a component steadily present in current contrast media and in a variety of medications. We report and compare with published literature the clinical and sonographic findings in a case of iodide mumps that developed after the intravenous administration of iodine-based contrast media for a contrast-enhanced computed tomography scan. The exact pathogenesis is unknown to date: based on sonographic appearance, we support the hypothesis of an acute inflammatory condition elicited by iodine accumulation in the salivary glands. The emergency care practitioner needs to be confident with the clinical symptoms as well as the sonographic findings and therapeutic options to successfully manage this condition.

Swelling of the salivary glands, also known as iodide or iodine mumps, is a rare adverse reaction to administration of iodine, a component steadily present in current contrast media and in a variety of medications. We report and compare with published literature the clinical and sonographic findings in a case of iodide mumps that developed after the intravenous administration of iodine-based contrast media for a contrast-enhanced computed tomography scan. The exact pathogenesis is unknown to date: based on sonographic appearance, we support the hypothesis of an acute inflammatory condition elicited by iodine accumulation in the salivary glands. The emergency care practitioner needs to be confident with the clinical symptoms as well as the sonographic findings and therapeutic options to successfully manage this condition.

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

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.