复发性静脉造影剂诱导的颌下腺炎：一例病例报告及文献综述

文献信息

中文摘要

背景 碘造影剂诱导的涎腺炎（碘性腮腺炎）是一种罕见且未被充分认识的碘造影剂迟发性非过敏性不良反应。其特征为一个或多个唾液腺的无痛性或疼痛性肿胀，通常在造影剂暴露后数小时发生。病例报告 一名75岁泰国女性，患有3a期慢性肾病，因长期支气管扩张被转诊进行增强胸部计算机断层扫描（CT）成像。由于她报告10年前静脉注射造影剂后不久曾出现双侧颈部和颌下肿胀，因此处方口服泼尼松龙进行预处理。然而，在静脉注射碘普罗胺（370 mg I/mL）后延迟发作（16小时），她出现疼痛性双侧颌下肿胀并返回医院。体格检查显示双侧颌下腺坚实、轻度压痛性肿胀，表面无红斑，Wharton管开口无脓性分泌物。未观察到喉水肿或支气管痉挛。超声检查显示双侧颌下腺弥漫性增大，回声纹理不均，血管增多，轻度腺内导管扩张，无涎石症或脓肿证据。基于特征性超声表现和与造影剂给药的时间关系，诊断为再次暴露后复发性碘造影剂诱导的双侧颌下腺炎。保守治疗包括热敷和口服镇痛药，症状在4天内完全缓解。结论 碘造影剂诱导的涎腺炎是一种罕见的、自限性的碘造影剂迟发反应，再次暴露后可复发。认识其典型的临床和影像学表现对于帮助诊断、避免误诊和不必要的造影剂暴露、预处理、检查及治疗非常重要。

英文摘要

BACKGROUND Iodinated contrast-induced sialadenitis (iodide mumps) is a rare and underrecognized delayed non-allergic adverse reaction to iodinated contrast media. It is characterized by painless or painful swelling of 1 or more salivary glands, typically occurring several hours after contrast exposure. CASE REPORT A 75-year-old Thai woman with stage 3a chronic kidney disease was referred for contrast-enhanced chest computed tomography (CT) imaging to evaluate longstanding bronchiectasis. Because she reported a prior episode of bilateral neck and submandibular swelling shortly after intravenous contrast administration 10 years earlier, premedication with oral prednisolone was prescribed. However, with a delayed onset (16 hours) after intravenous administration of iopromide (370 mg I/mL), she developed painful bilateral submandibular swelling and returned to the hospital. Physical examination revealed firm, mildly tender bilateral submandibular swelling without overlying erythema or purulent discharge from the openings of Wharton's ducts. No laryngeal edema or bronchospasm was observed. Ultrasonography demonstrated diffuse enlargement of both submandibular glands, with heterogeneous echotexture, increased vascularity, and mild intraglandular ductal dilatation, without evidence of sialolithiasis or abscess. Based on the characteristic sonographic findings and the temporal relationship with contrast administration, a diagnosis of recurrent iodinated contrast-induced bilateral submandibular sialadenitis after re-exposure was made. Conservative management with warm compresses and oral analgesics resulted in complete symptom resolution within 4 days. CONCLUSIONS Iodinated contrast-induced sialadenitis is a rare, self-limited delayed reaction to iodinated contrast media that can recur after re-exposure. Recognition of its characteristic clinical and imaging findings is important to aid diagnosis and avoid misdiagnosis and unnecessary contrast exposure, premedication, investigations, and treatment.