Clinically evident enlargement of parotid glands occurs in 610% of patients.1–3 Increased parotid uptake of 67-gallium occurs in 40 to 89% of patients with sarcoidosis, even in the absence of specific symptoms.2–5
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CHAPTER 10
The Parotid and Other Salivary Glands and Lachrymal Glands
FIGURE 10.1 Usually parotid gland enlargement in sarcoidosis responds to medical treatment. This patient was first seen by a surgeon who decided to take out both the glands (see also Figure 10.3).
FIGURE 10.2 Biopsy sample of noncaseating granuloma of the parotid gland.
FIGURE 10.3 Parotid gland enlargement is a recognized feature of sarcoidosis and is almost always bilateral. Although parotid enlargement has many causes, in menopausal women one always thinks of Sjögren’s syndrome.5
64 Atlas of Sarcoidosis
CLINICAL APPEARANCE:
ASYMPTOMATIC
Sarcoid parotitis may be asymptomatic but is otherwise characterized by symptomatic enlargement of the parotid gland that is usually bilateral and results in the symptom
of mouth dryness. Occasionally, the enlargement may be unilateral. Enlargement of the lacrimal glands, kerato- conjunctivitis sicca, and salivary gland involvement are features that resemble Sjögren’s syndrome.
Clinical Appearance: Uveoparotid Fever Uveoparotid fever is known as Heerfordt’s syndrome.
Swelling of one or both parotid glands, fever, and uveitis with or without the seventh cranial nerve palsies exist concurrently in half of the affected patients.4
REFERENCES
1. Neville E, Mills R, Jash D. Sarcoidosis of the upper respira- tory tract and its association. Thorax 1976;31:660–664.
2. Olivieri D, Marsi M. Parotid involvement in sarcoidosis. Sem Resp Med 1992;13:520–524.
3. Brantley S, Orzel J, Weiland F, et al. Parotid gland biopsy and 67__GA uptake imaging correlation in systemic sarcoidosis.
Chest 1987;91:403–407.
4. James D, Sharma O. Parotid gland sarcoidosis. Sarcoidosis Vascul Diff Lung Dis 2000:17:27–32.
5. Brantley S, Orzel J, Weiland F, et al. Parotid gland biopsy and 67-GA imaging correlation in systemic sarcoidosis. Chest 1987;91:403–407.
FIGURE 10.4 Bilateral lachrymal involvement in a young African-American patient.
FIGURE 10.5 Biopsy of the lachrymal gland showing noncaseat- ing granuloma.
FIGURE 10.6 This patient has only unilateral involvement of the tarsal plate. Note the swelling above the left eye. The biopsy also showed noncaseating granulomas.
