Diagnostic Imaging Pathways - Salivary Gland Swelling

Pathway Home

Population Covered By The Guidance

This pathway provides guidance on the imaging of adult patients with salivary gland swelling.

Date reviewed: January 2012

Date of next review: January 2015

Quick User Guide

Move the mouse cursor over the PINK text boxes inside the flow chart to bring up a pop up box with salient points.
Clicking on the PINK text box will bring up the full text.
The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.

No radiation None 0
Minimal radiation Minimal < 1 millisieverts
Low radiation Low 1-5mSv
Medium radiation Medium 5-10 mSv
High radiation High >10 mSv


Pathway Diagram


Image Gallery

Note: These images open in a new page
1a Click to view full size image

Salivary Gland Swelling with Ductal Narrowing

Image 1a and 1b (Sialogram): There is considerable dilatation of the intraglandular radicles particularly low in the gland. The parotid duct has a narrowing just distal to the confluence with the accessory duct (arrow), this latter not being dilated. The narrow segment is fairly short and is only a relative narrowing, not an obstruction. There is no calculus identified.

1b Click to view full size image
2a Click to view full size image

Salivary Gland Tumour

Image 2a and 2b: Resection of the parotid gland showing a (a) pleomorphic adenoma with the typical well circumscribed, pale appearance and focal areas of chondroid (cartilagenous) differentiation (arrow) and a (b) Warthin's tumour (Papillary cystadenoma lymphomatosum) with a tan cut surface demonstrating several cystic spaces.

2b Click to view full size image

Teaching Points

Teaching Points

  • Ultrasound is the initial imaging modality in suspected salivary gland disease
    • In suspected sialolithiasis, MR sialography is the prefered non-invasive investigation for further assessment of salivary gland calculi
    • With a salivary gland mass, CT or MRI can be used for further investigation



  1. Murray ME, Buckenham TM, Joseph AEA. The role of ultrasound in screening patients referred for sialography: a possible protocol. Clin Otolaryngol Allied Sci. 1996;21:21-3. (Level III evidence)
  2. Gritzmann N. Sonography of the salivary glands. AJR Am J Roentgenol. 1989;153:161-6. (Level III evidence)
  3. Jager L, Menauer F, Holzknecht N, et al. Sialolithiasis: MR sialography of the submandibular duct - an alternative to conventional sialography and US? Radiology. 2000;216:665-71. (Level II evidence) View the reference
  4. Yousem DM, Kraut MA, Chalian AA. Major salivary gland imaging. Radiology. 2000;216:19-29. (Review article)
  5. Casselman JW, Mancuso AA. Major salivary gland masses: comparison of MR imaging and CT. Radiology. 1987;165:183-9. (Level III evidence)
  6. Bryan RN, Miller RH, Ferreyro RI, et al. Computed tomography of the major salivary glands. AJR Am J Roentgenol. 1982;139:547-54. (Level III evidence)
  7. Avrahami E, Englender M, Chen E, et al. CT of submandibular gland sialolithiasis. Neuroradiology. 1996;38:287-90. (Level II/III evidence)
  8. Choi DS, Na DG, Byun HS, et al. Salivary gland tumors: evaluation with two-phase helical CT. Radiology. 2000;214:231-6. (Level II/III evidence)
  9. Berg HM, Jacobs JB, Kaufman D, et al. Correlation of fine needle aspiration biopsy and CT scanning of parotid masses. Laryngoscope. 1986;96:1357-62. (Level III evidence)
  10. Kaneda T, Minami M, Ozawa K, et al. Imaging tumors of the minor salivary glands. Oral Surg Oral Med Oral Pathol. 1994;77:385-90. (Level IV evidence)
  11. Silvers AR, Som PM. Salivary glands. Radiol Clin North Am. 1998;36(5):941-66. (Review article)
  12. Buckenham TM, George CD, McVicar D, et al. Digital sialography: imaging and intervention. Br J Radiol. 1994;67:524-9. (Level II/III evidence)
  13. Becker M, Marchal F, Becker CD, et al. Sialolithiasis and salivary ductal stenosis: diagnostic accuracy of MR sialography with a three-dimensional extended-phase conjugate-symmetry rapid spin-echo sequence. Radiology. 2000;217:347-58. (Level II evidence) View the reference
  14. Sack MJ, Weber RS, Weinstein GS, et al. Image-guided fine-needle aspiration of the head and neck: five years' experience. Arch Otolaryngol Head Neck Surg. 1998;124:1155-61. (Level III evidence)
  15. Yousem DM, Sack MJ, Weinstein GS, et al. Computed tomography-guided aspirations of parapharyngeal and skull base masses. Skull Base Surg. 1995;5:131-6. (Level III evidence)
  16. Thoeny H C. Imaging of salivary gland tumours. Cancer Imaging. 2007;7(1):52-62. (Review article)
  17. Lee YY, Wong KT, King AD, Ahuja AT. Imaging of salivary gland tumours. Eur J Radiol. 2008;66(3):419-36. (Review article)
  18. Parker GD, Harnsberger HR. Clinical-radiologic issues in perineural tumor spread of malignant diseases of the extracranial head and neck. Radiographics. 1991;11(3):383-99. (Level III evidence)

File Formats

Some documents for download on this website are in a Portable Document Format (PDF). To read these files you might need to download Adobe Acrobat Reader.

Get Adobe Reader