|Year : 2015 | Volume
| Issue : 4 | Page : 116-117
Recurrent Iodinated Contrast Material-Induced Sialadinitis
Shanmuga Sundaram Rathakrishnan, Murali Alagesan, Tamilarasu Kaliappan, Rajendiran Gopalan
Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
|Date of Web Publication||21-Dec-2015|
Shanmuga Sundaram Rathakrishnan
Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore - 641 004, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Iodinated contrast material (ICM) can rarely cause sialadinitis. Here we report a case of unilateral parotitis following coronary angioplasty, which subsided with conservative management. He also had a past history of similar illness following previous angiogram. Direct toxic effect of the contrast material or idiosyncratic reaction has been considered as the possible etiology.
Keywords: Angiogram, iodinated contrast material, sialadenitis
|How to cite this article:|
Rathakrishnan SS, Alagesan M, Kaliappan T, Gopalan R. Recurrent Iodinated Contrast Material-Induced Sialadinitis. Heart India 2015;3:116-7
| Introduction|| |
Iodinated contrast material (ICM) can cause various toxic and allergic reactions. One of the rare reactions is iodinated contrast-induced sialadenitis. Iodinated contrast-induced parotitis is a self-limiting entity, which subsides spontaneously in most of the cases. We report a rare case of recurrent ICM-induced parotitis, which subsided with conservative management.
| Case Report|| |
A 60-year-old male patient, a known case of coronary artery disease, was admitted with a history of rest angina. He underwent conventional coronary angiogram an year back, which showed hemodynamically significant lesions involving left anterior descending artery (LAD) and right coronary artery (RCA). He was suggested to undergo percutaneous angioplasty for which he was not willing. He also underwent a computerized tomography (CT) coronary angiography 6 months later when he had chest pain, which also showed a similar picture. He denied revascularization then. On evaluation, he was hemodynamically stable. Electrocardiogram showed dynamic T wave changes in inferior leads. Troponin T was not elevated. Other routine blood investigations were within normal limits. Echocardiography showed no regional wall motion abnormality and good left ventricular systolic function. He underwent conventional coronary angiogram, which showed double vessel coronary artery disease involving LAD and RCA. He underwent ad hoc coronary angioplasty with stenting to LAD and RCA with drug-eluting stents.
Subsequently 12 hours after the procedure, he complained of pain over the left parotid region with swelling [Figure 1]. On clinical evaluation, he had tenderness and swelling over the left parotid region. Right parotid region was normal. Repeat white blood cell count was normal. On detailed history, patient had a similar swelling involving the left parotid region after the previous angiogram, which subsided after two days. He had unilateral swelling involving only the left parotid region during the previous episode too. He denied any such symptom after the CT coronary angiogram done 6 months after the first angiogram. Since the patient had a history of similar illness, he was not further evaluated with any other imaging modalities. A diagnosis of recurrent ICM-induced parotitis was made. Pain was managed with analgesics. Patient did not have any feature of facial nerve compression. Symptoms and parotid swelling subsided and he made an uneventful recovery after 2 days.
|Figure 1: This picture shows a swelling in the left parotid region (white arrow) where as the right parotid region is normal (Black arrow)|
Click here to view
| Discussion|| |
The term iodide mumps was introduced by Sussman and Miller in 1956. They first described sialadenitis following intravenous administration of ICM.  After intravenous administration, most of it is eliminated by the kidney. The concentration of iodine has been reported to reach 100 times that of the plasma level in salivary glands.  This high concentration causes inflammatory edematous swelling of the mucosal duct and obstruction, which results in swelling of the glands.  In the presence of renal failure, iodine concentration may increase in the salivary glands where it may exert a toxic effect.  However, most of the reports of sialadenitis following ICM are reported in cases with normal renal function  as in our case. Idiosyncratic mechanism was also considered.  Sialadinitis has been reported to occur as a prodrome to anaphylactic shock following the usage of ICM.  Other causes of parotitis-like dehydration were not considered because he was adequately hydrated prior to the procedure. Septic etiology was not considered since white blood cell counts were within normal limits and he had similar episode prior following coronary angiogram.
ICM-induced parotitis happens within few hours to 5 days as in our case which happened after 12 hours. ICM-induced sialadinitis may affect all the salivary glands and in some patients there may be involvement of submandibular, sublingual and parotid glands as well. It is usually bilateral. In contrast to our case, submandibular glands were involved (71%) more commonly than parotid glands.  Our patient had involvement of left parotid gland and not the right during both the episodes. It is possible that the patient would have had a subclinical involvement of right parotid gland. Unilateral parotitis following iodinated contrast usage has been reported earlier.  Recurrent sialadenitis following repeat contrast medium administration as in our case has also been reported earlier.  It is not clear whether the type of contrast material has any influence on the occurrence of the sialadenitis. In our case, low osmolar contrast was used during the conventional coronary angiogram (40 ml of Iohexol 350), angioplasty (120 ml of Iohexol 350) and CT coronary angiogram (80 ml of Iohexol 350). The reason for non-occurrence of parotitis in our case following CT coronary angiogram is not clear.
ICM-induced parotitis is a self-limiting entity and usually resolves spontaneously without any complications as in our case. It usually settles with supportive management with analgesics. Life-threatening reaction has never been reported so far with this condition. It may require steroids  if it is not subsiding to conservative management. Facial nerve compression requiring surgical decompression has rarely been reported following the same. 
| Conclusion|| |
ICM-induced parotitis is a rare clinical entity, which has to be kept in mind when a patient has parotid swelling in the post-procedural period. This is a self-limiting entity which usually resolves with supportive management. Facial nerve compression is the only complication reported with this entity.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
| References|| |
Miller J, Sussman RM. Iodide mumps after intravenous urography. N Engl J Med 1956;255:433-4.
Talner LB, Lang JH, Brasch RC, Lasser EC. Elevated salivary iodide and salivary gland enlargement due to iodinated contrast media. Am J Roentgenol Radium Ther Nucl Med 1971;112:380-2.
Kohri K, Myoshi S, Nagahara A, Ohtani M. Bilateral parotid enlargement (Iodide mumps) following excretory urography. Radiology 1977;122:654.
Dallo ML, Mariottini CJ, Durand P, Meyer P, Schmitt R, Vicario J, et al
. "Iodide mumps" after coronary angioplasty. Int J Cardiol 2007;114:396-7.
Capoccia L, Sbarigia E, Speziale F. Monolateral sialadenitis following iodinated contrast media administration for carotid artery stenting. Vascular 2010;18:34-6.
Bohora S, Harikrishnan S, Tharakan J. Iodide mumps. Int J Cardiol 2008;130:82-3.
Melki P, Mugel T, Cléro B, Hélénon O, Belin X, Moreau JF. Acute bilateral parotitis. Isolated prodrome to anaphylactoid shock following injection of iodinated contrast media. J Radiol 1993;74:51-4.
Christensen J. Iodide mumps after intravascular administration of a nonionic contrast medium. Case report and review of the literature. Acta Radiol 1995;36:82-4.
Koch RL, Byl FM, Firpo JJ. Parotid swelling with facial paralysis: A complication of intravenous urography. Radiology 1969;92:1043-4.
Cansel M, Yagmur J, Cuglan B, Tasolar H. Iodide-induced parotitis after coronary angiography. Hong Kong J Emerg Med 2011;18:421-3.