Tükürük Bezlerinin Ultrasonografik İncelemesi
Özet
Tükürük bezi hastalıklarının klinik bulguları benzerlik gösterdiğinden, doğru teşhis için görüntüleme yöntemleri büyük önem taşımaktadır. Yüksek çözünürlüklü transduserlerin kullanıldığı ultrasonografi (US), majör tükürük bezlerinin (parotis, submandibular ve sublingual) incelenmesinde radyasyon içermeyen ve invaziv olmayan yapısıyla öncül teşhis metodu olarak öne çıkmaktadır. İnceleme sırasında lezyonların bilateral ortaya çıkma eğilimi nedeniyle her iki taraf da değerlendirilmeli, tümör şüphesinde servikal lenf nodları incelenmeli ve damar yoğunluğunu belirlemek için renkli Doppler'den yararlanılmalıdır. Tükürük bezi enfeksiyonları (sialitis); viral, akut/kronik bakteriyel parotitis ve submandibulitis olarak sınıflandırılmakta, US ile abse oluşumu ve lithiasis gibi duktal tıkanıklıklar ayırt edilebilmektedir. Ayrıca sialozis, siyaloadenozis ve Sjögren sendromu gibi kronik sistemik veya otoimmün hastalıklarda bezlerde hiperekoik büyüme, heterojenlik ve fibrotik değişimler izlenmektedir. Pleomorfik adenom ve Warthin tümörü gibi benign tümörler genellikle iyi sınırlı ve homojen yapıda izlenirken; mukoepidermoid ve adenoid kistik karsinom gibi malign tümörler düzensiz sınırlar, nekroz alanları ve yüksek vaskülarizasyon göstermektedir. Sonuç olarak US, anatomik limitasyonlarına rağmen yumuşak doku patolojilerinin teşhis ve takibinde diagnostik açıdan üstün bir avantaja sahiptir.
Since clinical findings of salivary gland diseases overlap, imaging modalities are crucial for accurate diagnosis. Ultrasonography (US) utilizing high-resolution transducers stands out as a primary non-invasive and non-ionizing diagnostic method for examining major salivary glands (parotid, submandibular, and sublingual). Due to the bilateral nature of many lesions, both sides should be evaluated, cervical lymph nodes must be examined in case of suspected tumor, and color Doppler should be utilized to assess vascular density. Salivary gland infections (sialitis) are classified as viral, acute/chronic bacterial parotitis, and submandibulitis, where US helps differentiate abscess formation and ductal obstructions like lithiasis. Furthermore, chronic systemic or autoimmune conditions such as sialosis, sialoadenosis, and Sjögren's syndrome present with hyperechoic enlargement, heterogeneity, and fibrotic changes in the glands. While benign tumors like pleomorphic adenoma and Warthin's tumor typically appear well-defined and homogeneous, malignant tumors such as mucoepidermoid and adenoid cystic carcinoma exhibit irregular borders, necrotic areas, and increased vascularity. In conclusion, despite its anatomical limitations, US offers superior diagnostic advantages in evaluating and monitoring soft-tissue pathologies.
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