Sjögren’s Syndrome: An Incidental Radiologic Finding in a Patient with Aural Symptoms
Ukamaka Nwankwo*1, Ifedayo Ajayi2, Junaid Ayinde3 and Ibukun
1ENT Surgeon, Evercare Hospital Lekki, Nigeria
2Consultant Radiologist, Department of Radiology, Evercare Hospital Lekki,
3Consultant Radiologist, Department of Radiology, Evercare Hospital Lekki,
4Consultant Radiologist, Department of Radiology, Evercare Hospital Lekki, Nigeria
*Corresponding Author: Ukamaka Nwankwo, ENT Surgeon, Evercare Hospital Lekki, Nigeria.
February 20, 2023; Published: March 21, 2023
Sjögren’s syndrome, an immune-mediated disorder of the exocrine glands (lacrimal and salivary) affects acinar cell serous production leading to complaints of dryness of the eyes and mouth. Radiological imaging has been used as a non-invasive modality for the diagnosis of this condition.
This is a case report of incidental diagnosis of Sjögren’s syndrome in a 49-year-old female with left aural fullness and recurrent tinnitus. Incidental findings of scattered micro-calcifications and heterogeneity were seen in both parotid glands on computed tomography imaging and innumerable microcysts of low signal intensity on T1 and high signal intensity on T2/STIR, on magnetic resonance imaging of the temporal bone. These findings are pathognomonic for Sjögren’s syndrome.
The meticulous review of computed tomography and magnetic resonance images help to detect silent lesions and the awareness of audio-vestibular involvement in Sjögren’s syndrome can lead to prompt diagnosis and the monitoring of disease progression.
Keywords: Sjögren’s Syndrome; Parotid Gland; Computed Tomography; Magnetic Resonance Imaging; Lacrimal Gland; Pneumatised Temporal Bone; Aural
- Skarlis C., et al. “Sjögren’s syndrome: Recent updates”. Journal of Clinical Medicine 2 (2022): 399.
- Takagi Y., et al. “Comparison of salivary gland MRI and ultrasonography findings among patients with Sjögren’s syndrome over a wide age range”. Rheumatology5 (2022): 1986-1996.
- Van Ginkel MS., et al. “Imaging in primary sjögren’s syndrome”. Journal of Clinical Medicine 8 (2020): 2492.
- Danchaivijitr N., et al. “MRI of the parotid glands in a patient with Sjögren’s syndrome”. Eurorad (2006).
- Fox RI. “Sjögren’s syndrome”. Lancet 366 (2005): 321.
- Okawa Y and Ihara K. “Sensorineural hearing loss in sjögren’s syndrome”. International Journal of Molecular Sciences 23 (2022):
- Tucci M., et al. “Sjögren’s syndrome: an autoimmune disorder with otolaryngological involvement”. ACTA Otorhinolaryngologica Italica 3 (2005): 139-144.
- Ralli M., et al. “Audiovestibular symptoms in systemic autoimmune diseases”. Journal of Immuno Research 2018 (2018): 5798103.
- Vitali C and Del Papa N. “Classification and diagnostic criteria in sjögren’s syndrome: A long-standing and still open controversy”. Annals of the Rheumatic Diseases 76 (2017): 1953-1954.
- Bootsma H., et al. “Toward new classification criteria for sjögren’s syndrome?” Arthritis and Rheumatology 65 (2013): 21-23.
- Baldini C., et al. “Imaging in primary sjögren’s syndrome: The “obsolete and the new”. Clinical and Experimental Rheumatology 36 (2018): 5215-5221.
- Zhou M., et al. “Diagnostic accuracy of salivary gland ultrasonography with different scoring systems in Sjögren’s syndrome: a systematic review and meta-analysis”. Scientific Report 1 (2018): 17128.
- Carotti M., et al. “Diagnostic value of major salivary gland ultrasonography in primary sjögren’s syndrome: The role of grey-scale and colour/power doppler sonography”. Gland Surgery 8 (2019): S159-S167.
- Mossel E., et al. “Scoring hypoechogenic areas in one parotid and one submandibular gland increases feasibility of ultrasound in primary sjögren’s syndrome”. Annals of the Rheumatic Diseases 77 (2018): 556- 562.
- Cornec D., et al. “Salivary gland ultrasound to diagnose Sjögren’s syndrome: a claim to standardize the procedure”. Rheumatology (Oxford) 1 (2015): 199-200.
- Afzelius P., et al. “Imaging of the major salivary glands”. Clinical Physiology and Functional Imaging 1 (2016): 1 -10.
- Izumi M., et al. “Premature fat deposition in the salivary glands associated with Sjögren’s syndrome: MR and CT evidence”. American Journal of Neuroradiology 18 (1997): 951-958.
- Lemon SI., et al. “Salivary gland imaging in Sjögren’s syndrome”. Future Rheumatology 1 (2007): 83-92.
- De Vita S., et al. “Current limitations and ongoing iniatives to evaluate the activity, damage and outcome of primary Sjögren’s syndrome”. Clinical and Experimental Rheumatology 118 (2019): 24-26.
- Sreebay LM. “Saliva in health and disease: an appraisal and update”. Pathology - Research and Practice 3 (2000): 140-161.
- Theander E and Mandl T. “Primary Sjögren’s syndrome: diagnostic and prognostic value of salivary gland ultrasonography using a simplified scoring system”. Arthritis Care and Research 7 (2014): 1102-1107.
- Peck AB and Ambrus JC. “A temporal comparative RNS transcriptome profile of the annexon gene family in the salivary versus lacrimal glands of the sjögren’s syndrome susceptible C57BL/6.NOD-Aec2 mouse”. International Journal of Molecular Sciences 23 (2022): 11709.
- Vitali C., et al. “Parotid sialography and minor salivary gland biopsy in the diagnosis of Sjögren's syndrome: a comparative study of 84 patients”. Journal of Rheumatology 15 (1998): 262-267.
- Fox RI., et al. “Sjögren’s syndrome: proposed criteria for classification”. Arthritis and Rheumatology 29 (1986): 577-585.
- Cornec D., et al. “Contribution of salivary gland ultrasonography to the diagnosis of Sjögren’s syndrome: Havard new diagnostic criteria”. Arthritis and Rheumatology 1 (2013): 216-225.
- Ching A and Ahuja A. “Resolution on sonography of the submandibular space: Anatomy and abnormalities”. AJR American Journal of Roentgenology 3 (2002): 703-8.
- Sun Z., et al. “Diagnostic accuracy of parotid CT for identifying Sjögren’s syndrome”. European Journal of Radiology 10 (2012): 2702-2709.
- Izumi M., et al. “MR imaging of the parotid gland in Sjögren’s syndrome: a proposal for new diagnostic criteria”. AJR American Journal of Roentgenology 6 (1996): 1483-1487.
- Swiecka M., et al. “Imaging methods in primary sjögren’s syndrome as potential tools of disease diagnostics and monitoring”. Rheumatology 57 (2019): 336-342.
- Niemala RK., et al. “Ultrasonography of salivary glands in primary Sjögren’s syndrome. A comparison with magnetic resonance imaging and magnetic resonance sialography of parotid glands”. Rheumatology 7 (2004): 875.
- Andre R., et al “Comparison of clinical characteristics and magnetic resonance imaging of salivary glands with magnetic resonance sialography in sjögren’s syndrome”. Laryngoscope 1 (2021): E83-E89.
- Kojima I., et al. “Diagnostic performance of MR imaging of three major salivary glands for Sjögren’s syndrome”. Oral Disease 1 (2016): 84-90.
- Izumi M., et al. “MR features of the lacrimal gland in sjögren’s syndrome”. AJR 170 (1998): 1661-1666.
- Freling NJ. “Imaging of salivary gland disease”. Seminar on Roentgenology 1 (2000): 12-20.
- Freling N., et al. “Staging and follow-up of high-grade malignant salivary gland tumours: The role of traditional versus function imaging approaches-a review”. Oral Oncology 60 (2016): 157-166.
- Nishimura DA., et al. “Magnetic resonance imaging of salivary glands: a literature review”. Clinical and Laboratorial Research in Dentistry (2019): 1-6.
- Sayit AT., et al. “Temporal CT of the pneumatized petrous apex: Associated anomalies and the relationship with tinnitus and vertigo”. İstanbul Medical Journal 3 (2018): 225-230.
- Chapman PR., et al. “Petrous apex lesions: Pictorial review”. AJR American Journal of Roentgenology 3 (2011): WS26-WS37.
- Dong-Hee L., et al. “Anatomical factors influencing pneumatization of the petrous apex”. Clinical and Experimental Otorhinolaryngology 4 (2015): 339-344.
- Sosen E., et al. “Is there a relationship between subjective pulsatile tinnitus and petrous bone pneumatization?” Journal of Craniofacial Surgery 2 (2013): 461-463.
- Topal O., et al. “Subjective pulsatile tinnitus associated with extensive pneumatization of temporal bone”. European Archives of Otorhinolaryngology 265 (2008): 123-125.
- Tuz M., et al. “Subjective pulsatile tinnitus associated with extensive pneumatization of temporal bone”. Auris Nasus Larynx 30 (2003): 183-185.
- Ruckenstein NJ. “Autoimmune inner ear disease”. Current Opinion in Otolaryngology and Head and Neck Surgery 5 (2004): 426-430.
- Di Stadio A and Ralli M. “Systemic lupus erythematosus and hearing disorders: literature review and meta-anslysis of clinical and temporal bone findings”. The Journal of International Medical Research 5 (2016): 1470-1480.