Learning Radiology xray montage

Stone in Wharton's Duct

  • Most common disease of salivary glands
  • Twice as common in males as females
  • 80-95% occur in submandibular gland or duct
  • Stones are most common cause of acute and chronic infection of salivary glands
  • 80% of submandibular stones are opaque; 60% of parotid are opaque
    • Consist of mainly calcium phosphate
      • Not associated with systemic calcium abnormalities
    • Very unusual for patients to have a combination of radiopaque and non-opaque stones
  • Signs and symptoms
    • Pain and swelling of involved gland
      • Sialolithiasis causes pain and swelling of the involved salivary gland by obstructing the food-related flow of salivary secretions
      • Calculi may cause stasis of saliva facilitating bacterial ascent into the gland and subsequent infection
      • Some may be asymptomatic
  • Imaging
    • Plain radiography
      • Opaque stone in course of Wharton’s (submandibular) or Stensen’s (parotid) ducts
    • CT
      • Stone in duct
      • Ductal dilatation
    • MR
      • Inflammation of gland
    • Sialography is contraindicated in acute infection or in a patient with  a significant contrast allergy
  • Treatment
    • Conservative
    • Surgical removal
    • Lithotripsy 

 stone in wharton duct

Sialolithiasis. Contrast-enhanced CT of the neck demonstrates

a stone (blue arrow) in the submandibular region of a dilated

Wharton's Duct (red arrow).