Radiology · patient case question
Which imaging study best confirms the diagnosis?
Patient case: Neck swelling that worsens with meals
Patient: 41-year-old woman.
Chief complaint: A lump in my neck that swells up and hurts when I eat.
History: Three months of intermittent swelling. The swelling and pain build during meals and settle over the following hour. No fever, no weight loss.
Findings: A soft, doughy swelling in the anterior neck. Bimanual palpation of the floor of the mouth elicits tenderness along the course of the left submandibular duct. Scant saliva expressed from the duct orifice.
Show answer and explanation
Correct answer: C. Mandibular cross-sectional occlusal radiograph
- A. Periapical films image teeth and periapical bone, not the duct.
- B. A panoramic view superimposes the mandible over the floor of the mouth and frequently hides a stone.
- C. CORRECT. A cross-sectional OCCLUSAL film projects the floor of the mouth clear of the mandible and is the classic view for a radiopaque calculus in Wharton's duct. Roughly 80 to 85 percent of submandibular stones are sufficiently radiopaque to be seen. Where the film is negative but the history is convincing, ultrasound or sialography follows.
- D. Thyroid function tests would be relevant to a thyroid or thyroglossal lesion, not to an obstructed salivary duct.