Ultrasound findings of iodide mumps

Recurrent neck swelling after iodinated contrast media administration

A 74-year-old male with an abdominal aortic aneurism reported 2 episodes of neck swelling 16 hours after an abdominal CT with iodinated contrast media that reappeared in a subsequent CT, although the use of pre-medication. The tests used to exclude the hypersensitivity hypothesis where negative and once a new CT where needed we decided to do it with close monitoring. We performed a facial picture and cervical ultrasound exam before and 24 hours after the exam. The neck swelling and the ultrasound findings 24 hours after the CT made the diagnosis of contrast induced sialoadenitis possible. Contrast induced sialadentis is an uncommon adverse reaction to iodinated contrast media. As it presents with neck swelling it is important to exclude a hypersensitivity reaction because it's further limitations and make a differential diagnosis.

Contrast-Induced Sialadenitis of the Sublingual Glands

Contrast-induced sialadenitis (CIS) is a rare, delayed pseudoallergic reaction from iodine containing contrast. Previously reported cases of CIS demonstrated that the two major salivary glands (parotid and submandibular) can be affected. The initial encounter of this entity can raise alarms to physicians as the differential diagnoses include serious infectious and inflammatory conditions such as Ludwig's angina and angioedema. Subsequently, it may lead to unnecessary testing and increased healthcare cost. Here we present a 60-year-old male who presented with bilateral sublingual gland swelling following exposure to iodinated contrast. With timely diagnosis by the otolaryngologist, the patient received conservative management that led to a full resolution within a few days. To date, this is the first case of CIS only involving the sublingual glands. We conclude that CIS can involve any of the major salivary glands.

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.

Acute Submandibular Swelling Complicating Arteriography With Iodide Contrast: A Case Report and Literature Review

Iodide mumps is an uncommon condition induced by iodide-containing contrast. We present the first reported case of iodide mumps in mainland China, which occurred after carotid artery intervention.The patient, a 65-year-old Chinese male, had a history of dizziness, hypertension, diabetes, and right arm weakness. He had no history of allergies and had never previously received iodide-containing contrast. The patient's kidney function and other laboratory findings were normal. He underwent stenting of the left internal carotid artery (LICA) opening and received approximately 250 mL of a nonionic contrast agent (ioversol). Approximately 5 hours after angioplasty, bilateral local swellings were noted near the mandible; the masses were moderately firm and nontender.Iodide mumps was diagnosed in the patient. Intravenous dexamethasone (10 mg) was administered. The submandibular glands had shrunk by 11 hours after angioplasty, and they gradually became softer. The mandibular salivary glands had completely recovered by 5 days after surgery.Iodide mumps represents a rare late reaction to iodine-containing contrast media. This condition can occur in any patient receiving any iodinated contrast agent and may recur upon repeated exposure, but self-resolution can be expected within 2 weeks. All clinicians who use contrast media or iodide should be aware of this condition.

A complete resolution of sialadenitis induced by iodine containing contrast with intravenous dexamethasone infusion

Salivary gland enlargement following the administration of iodine is an extremely rare event, and the pathophysiology of iodine-induced sialadenitis is not yet fully known. The onset of symptoms can start within a few minutes to five days after contrast administration. The course of iodine-induced sialadenitis is extremely benign, and rapid resolution of symptoms is expected without treatment. We report the case of a 59-year-old white female who noted mildly painful swelling involving the right side of her face within five days of receiving intravenous iodine-containing contrast. A diagnosis of iodine-related sialadenitis was made. She was given 20 mg of decadron intravenously, with prompt resolution of the swelling within a few hours.

Iodide mumps: sonographic appearance

Swelling of the salivary glands occurring after injection of iodine-based contrast agent is a rare late adverse reaction. Only a few cases in the literature illustrate such ultrasound findings.

Swelling of the submandibular glands after administration of low-osmolarity contrast agent: Ultrasound findings

Swelling of the salivary glands occurring after injection of iodine based contrast agent is a rare late adverse reaction. Only a few cases in the literature report such diagnostic findings. We present our color Doppler ultrasound findings in a case of swelling of both submandibular glands occurring after administration of iodinated contrast agent.

Iodide mumps after contrast media imaging: a rare adverse effect to iodine

BACKGROUND

Exposure to iodinated contrast media may elicit a variety of adverse reactions. Anaphylactoid and delayed cell-mediated unwanted effects are common; rare adverse reactions include iodine-related sialadenopathy, iododerma, and acneiform eruptions.

OBJECTIVES

To describe the occurrence of iodide mumps in a patient examined using contrast-enhanced computed tomography and to outline differential diagnoses.

METHODS

A detailed diagnostic approach, including histologic analysis, skin tests, controlled reexposure, efficacy of premedication, and imaging studies, is presented. The findings unique to this reaction and differential diagnoses are highlighted.

RESULTS

While undergoing repeated contrast-enhanced computed tomography a patient developed recurrent swellings of the sublingual glands, identified as iodide mumps. These swellings resolved within a few days. Imaging studies and histologic analysis showed distinct patterns without inflammation. The important role of iodine in this adverse reaction is demonstrated.

CONCLUSIONS

Iodine from iodinated contrast media may rarely elicit noninflammatory edema of the salivary glands. The reaction should be differentiated from other swellings in the head and neck area.