Iodide mumps due to low-osmolality contrast material

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.

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.

Iodide Mumps after Intravascular Administration of a Nonionic Contrast Medium

Swelling of the submandibular, sublingual and/or parotid glands (“iodide mumps”) is an uncommon complication to intravascular administration of contrast material. The etiology remains unclear, but the reaction seems to be idiosyncratic or related to toxic accumulation of iodide in the ductal systems of the salivary glands. The introduction of nonionic contrast media has not eliminated the risk of developing iodide mumps. The first reported case of iodide mumps after intravascular administration of iopromide (Ultravist 300) is presented.

Iodide mumps following fistulogram in a haemodialysis patient

Iodide mumps, or contrast-induced acute sialadenitis, is characterised by rapid, painless enlargement of the salivary glands, following the use of iodinated contrast dye. The underlying mechanism of this adverse reaction is not completely understood. It could be due to an idiosyncratic reaction or related to deposition of iodide in the ductal systems of the salivary glands causing blockage and inflammation. With increasing renal dysfunction, the elimination half-life of the iodine-containing contrast dye gets prolonged. The course of iodine-induced sialadenitis is usually benign, and rapid resolution of symptoms is expected without definite treatment. The symptomatic management includes treatment with a parenteral non-steroidal anti-inflammatory drug (NSAID), steroids and dialysis. However, the role of steroids has been found to be controversial in previously published case reports. Pancreatic mumps and transient thyroid dysfunction were also reported in patients following iodinated contrast administration; the aetiology of this is thought to be similar to iodide-induced sialadenitis.

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.

Iodide mumps

Acute sialadenitis following contrast administration is characterized by rapid, painless, bilateral enlargement of salivary glands, and is due to a rare adverse reaction to the administration of iodine containing contrast material. It is usually a benign, self-limiting condition and may recur with further exposure to iodinated contrast.

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.

Ultrasound findings of iodide mumps

Iodide mumps, swelling of salivary glands after contrast medium injection, is a rare adverse reaction. We present a case in a 73-year-old man with advanced gastric cancer. About 10 min after a CT scan performed with intravenous injection of 140 ml of the low osmolality contrast agent Ioxaglate (Hexabrix 320, Guerbet, France), he complained of progressive swelling of the submandibular area. Ultrasound showed diffuse swelling and internal low echoic thick septa in the submandibular glands bilaterally. Approximately 1 h afterwards, the swelling of his submandibular glands started to regress and returned to normal within a day.

Morbidity from parotid sialography

OBJECTIVE

Sialography is commonly used for the diagnosis of Sjögren's syndrome, although its invasive nature is often regarded as a serious drawback for routine usage. The aim of this study was to evaluate the morbidity and acceptability of parotid sialography using oil-based contrast fluid.

STUDY DESIGN

Twenty-four consecutive sialographic procedures were evaluated in terms of morbidity and the patient's acceptance of the procedure, assessed with a standardized questionnaire. Information was also obtained by recording relevant physical parameters during the procedure.

RESULTS

There was good acceptance of the sialographic procedure, and the morbidity was low. No signs of overfilling or false route were observed in any of the sialograms. On average, 0.74 mL of contrast fluid was infused with a velocity of 0.01 mL/s. The whole procedure was completed within 12 minutes.

CONCLUSIONS

Parotid sialography appears less invasive than is often thought. It had a low morbidity rate and was well accepted by the patients.