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Year : 2002  |  Volume : 12  |  Issue : 2  |  Page : 297-298
Ultrasonographic diagnosis of an unusual case of sub-mandibular salivary gland enlargement due to a hydatid cyst


Department of Radiology, Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New Delhi, India

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How to cite this article:
Hemal U, Khurana J. Ultrasonographic diagnosis of an unusual case of sub-mandibular salivary gland enlargement due to a hydatid cyst. Indian J Radiol Imaging 2002;12:297-8

How to cite this URL:
Hemal U, Khurana J. Ultrasonographic diagnosis of an unusual case of sub-mandibular salivary gland enlargement due to a hydatid cyst. Indian J Radiol Imaging [serial online] 2002 [cited 2019 Nov 18];12:297-8. Available from: http://www.ijri.org/text.asp?2002/12/2/297/28465
Sir,

This 28 year old lady presented with history of a gradually increasing painless swelling in the left sub-mandibular region for 4 years. She gives a history of low grade intermittent fever for 2 years. There was no history of pain during mastication.

On examination, she had a non-tender swelling firm in consistency in the left submandibular region measuring 3x3 cm in size. It was bidigitally palpable. The overlying skin was free. The Oral cavity was normal. There was no hypoglossal nerve function deficit. There was no lymph node enlargement either in the cervical region or anywhere else. Systemic examination was unremarkable. X-ray mandible, left oblique view, demonstrated a soft tissue shadow in the left sub-mandibular region. [Figure - 1]. Ultrasonography, with 7.5 MHz transducer, revealed a double walled cystic lesion measuring 3.6 x 2.0 cm. The outer wall was 5 mm thick, hypoechoic and quite rigid; whilst the inner echogenic wall was 3 mm thick [Figure - 2]. This cystic mass was biloculated [Figure - 3]. On the basis of ultrasonography, the possibility of hydatid was kept in mind and the needle aspiration cytology of the cystic mass was performed, which demonstrated fluid containing parasites (echinococcus oligarthrus) suggestive of hydatid cyst. Submandibular salivary gland excision, inclusive of the cystic mass, was performed. Histopathology confirmed the diagnosis of a hydatid cyst of the sub-mandibular salivary gland.

On detailed search of the literature, we could encounter only one similar case of this rare variant of the echinococcus species. As previously reported, the present case has been diagnosed by fine needle aspiration cytology.[1] There are only four cases of sub-mandibular salivary gland hydatid cyst reported in the literature. This may be in conjunction with similar cysts in the thyroid.[2] gland Screening of other organs, such as the lungs or liver, to rule out their involvement is necessary in these cases[3]. Since it takes longer than a couple of years (the duration in this case was of 2 years) one does not expect to see daughter cysts in hydatid cysts presenting in the head and neck because of relatively early presentation in comparison to those in the liver. Surgical extirpation is the best option as seen in this case. Ultrasonographic features of hydatid cyst as in the present case can be a double walled cystic lesion with loculation. The outer wall (pericyst) was hypoechoic and rigid; whilst the inner wall was echogenic. If daughter cysts are present, these can be picked up on USG. However, the final diagnosis is made either on FNAC or histopathological examination



 
   References Top

1.Kini U, Shariff S, Nirmala V. Aspiration cytology of Echinococcus oligarthrus; a case report. Acta Cytol 1997; 41 (2): 544-8  Back to cited text no. 1    
2.Gurses N. Baysal K, Gurses N. Hydatic cyst in the thyroid and submandibular salivary glands in a child. Z Kinderchir 1986; 41 (6): 362-3  Back to cited text no. 2    
3.Onerci M, Turan E, Ruacan S. Submandibular hydatid cyst: a case report. J Cranio Maxillo-Fac Surg 1991; 19 (8): 359-61.   Back to cited text no. 3    

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Correspondence Address:
U Hemal
Department of Radiology, Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


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[Figure - 1], [Figure - 2], [Figure - 3]



 

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