Harper, Hillary

Harrison, Benjamin

Laselle, Brooks

Walsh, Ryan M.

English

PubMed

Walsh, Ryan M

eScholarship - University of California

UC IrvineWestern Journal of Emergency Medicine: Integrating Emergency Care with Population HealthTitleUltrasound Diagnosis of Acute  Neck Pain and SwellingPermalinkhttps://escholarship.org/uc/item/2b08048nJournalWestern Journal of Emergency Medicine: Integrating Emergency Care with Population Health, 11(2)ISSN1936-900XAuthorsWalsh, Ryan MHarper, HillaryLaselle, Brookset al.Publication Date2010Copyright InformationCopyright 2010 by the author(s).This work is made available under the terms of a Creative Commons Attribution-NonCommercial License, available at https://creativecommons.org/licenses/by-nc/4.0/ Peer reviewedeScholarship.org Powered by the California Digital LibraryUniversity of CaliforniaWestern Journal of Emergency Medicine        224 Volume XI, no. 2  :  May 2010and 3) saliva is more alkaline, with a higher mucin and calcium content.Ultrasound is 90% accurate in diagnosing sialolithiasis and was instrumental in the management of this patient.2 The initial plan was to administer IV antibiotics and obtain computed tomography (CT), to rule out a possible abscess. Ultrasound clinched the diagnosis in a rapid, accurate manner and permitted the avoidance of a CT scan and the associated radiation, cost and time delays.The treatment of sialoliths generally involves conservative management. Patients with symptoms persisting for more than a few days should be referred to Otolaryngology. Sialoendoscopy, fluoroscopy-guided wire basket extraction, lithotripsy, and open surgical removal are options when expectant management fails or is inappropriate. Typically stones less than 2 mm in diameter can be treated without surgical intervention.3Ryan M. Walsh, MDHillary Harper, MDBrooks Laselle, MDBenjamin Harrison, MDimage in emergency medicineUltrasound Diagnosis of Acute Neck Pain and SwellingMadigan Army Medical Center, Department of Emergency Medicine, Tacoma, WASupervising Section Editor: Sean Henderson, MDSubmission history: Submitted March 11, 2010; Accepted March 22, 2010Reprints available through open access at http://escholarship.org/uc/uciem_westjem[West J Emerg Med 2011; 11(2):224-225].A 33-year-old man presented to the emergency department with two days of right-sided facial and submandibular swelling. He denied fevers, shortness of breath, difficulty swallowing or recent dental problems. The patient’s medical history was unremarkable and he had no similar prior symptoms. Physical exam was notable for a tender, firm, right-sided neck mass below the angle of the mandible and a tongue-like, soft-tissue protrusion of the right sublingual region (Figure 1). A bedside ultrasound was performed revealing two sialoliths and ductal dilatation (Figure 2). Otolaryngology was consulted and the stones were subsequently removed two days later via a transoral approach.Sialolithiasis occurs most commonly in the submandibular gland (80%), followed by the parotid (15%), and the sublingual (<5%).1 The submandibular gland is more prone to calculi because: 1) the duct is longer and larger in diameter with slower saliva flow rates, 2) saliva flows against gravity, Figure 1. A) Right submandibular mass (arrow) and B) soft-tissue, sublingual mass (arrow).Volume XI, no. 2  :  May 2010         225 Western Journal of Emergency MedicineAddress for Correspondence: Ryan Walsh, MD, Dept. of Emergency Medicine, Madigan Army Medical Center, Bldg 9040 Fitzsimmons Ave, Tacoma, WA. 98431. Email: rdub88@gmail.com.The opinions or assertions contained herein are the private views of the authors and not to be construed as official or reflecting the views of the Department of the Army, the Department of Defense, or the U.S. Government.Walsh et al. Ultrasound Diagnosis of Acute Neck PainREFERENCES1. Austin T, Davis J, Chan T. Sialolithiasis of Submandibular Gland. Journal of Emergency Medicine. 2004; 26:221-3.2. Katz P, Hartl D, Guerre A. Clinical Ultrasound of the Salivary Glands. Otolaryngol Clin N Am. 2009; 42:973-1000. 3. Soares EC, Costa FW, Pessoa RM, et al. Giant salivary calculus of the submandibular gland. Otolaryngol Head Neck Surg 2009; 140:128-9.Figure 2. A) Ultrasound of submandibular gland depicting intraductal calculus with dilated duct. B) Sublingual ultrasound (using the endocavitary transducer) showing a second intraductal calculus with continued ductal dilatation.

Ultrasound Diagnosis of Acute  Neck Pain and Swelling

Walsh, Ryan M MD

Harper, Hillary MD

Laselle, Brooks MD

Harrison, Benjamin MD

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Western Journal of Emergency Medicine

Ultrasound Diagnosis of Acute Neck Pain and Swelling

Clinical Ultrasound of the Salivary Glands. Otolaryngol Clin N Am.

Giant salivary calculus of the submandibular gland. Otolaryngol Head Neck Surg

Sialolithiasis of Submandibular Gland.

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Ultrasound Diagnosis of Acute Neck Pain and Swelling

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