Two cases in which bilateral submandibular gland atrophy led to the diagnosis

Abstract

We herein report two cases that were able to be treated immediately based on a diagnosis of Sjogren syndrome (SS) made by confirming atrophy or the absence of submandibular glands on computed tomography (CT). The first case was a 79-year old man with a deep cervical abscess. He did not show typical inflammatory responses, such as an elevated C-reactive protein level or white blood cell count, but we still suspected SS based on his atrophy and absence of submandibular glands on neck CT. We were able to determine his specific course because certain cytokines suppress the usual inflammatory responses in some collagen diseases. Subclinical SS (SCSS) was diagnosed following a thorough inspection. The second case was an 83-year-old woman with chronic heart failure. She was admitted to the internal medicine department because her heart failure had worsened despite diuretic administration. Aspiration pneumonia was suspected based on CT, and she was introduced to the otolaryngology department to undergo an inspection of her swallowing function and the rumbling noise in her larynx that was produced when she ate. Of exacerbation of that disease. At the same time she complained of dysphagia and was suffering from aspiration pneumonia. We suspected SS based on her dry mouth and throat and severe atrophy of the submandibular glands on CT. Her dysphagia was attributed to her severe dry mouth and throat, as her swallowing function was found to be relatively good. Her symptoms first appeared after a diuretic had been administered to treat her worsening heart failure, and they improved on stopping the diuretic; we therefore concluded that her dysphagia and aspiration pneumonia had been caused by underlying dry mouth and throat that were worsened due to drug loading. There is necessary much opportunity to interpret CT of the neck at the department of otorhinolaryngology and head and neck surgery. Atrophy of the submandibular glands may help clarify the state of the disease and suggest potential diagnoses and treatments. We emphasize the need to interpret CT findings carefully, regardless of the presence of dry mouth. We also report here that 70% of the patients with SS in our clinic showed more than severe atrophy of the submandibular glands on CT.