International Journal of Research and Innovation in Applied Science (IJRIAS) |Volume VII, Issue XI, November 2022|ISSN 2454-6194
Ultrasonography of Lacrimal Gland involvement in systemic Sarcoidosis
Hadi Khazaei. M.D., M.S., M.C.R.*, Danesh Khazaei, Kaneez Abbas, Davin Ashraf, John D Ng.
Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, 97239, USA
*Corresponding author
Abstract: Lacrimal gland lesions generally present as palpable masses in the superolateral aspects of the orbits. Approximately 50% of lacrimal gland masses are inflammatory lesions, 25% are lymphoid lesions or lymphoma, and the other 25% are salivary gland type tumors. Although there are overlaps and exceptions, features such as laterality, portion of gland involvement, presence or absence of bony findings, enhancement pattern, and clinical presentation are valuable in differentiating among lacrimal gland lesions. The 3D ultrasound has been used to define lacrimal gland shape, size, density, structural features the pattern of blood supply, as well as the anatomic and topographic position in the orbit. The study was conducted in the B- and 3D-modes of ultrasonography with color and energy Doppler mapping on both sides.
Keywords: Lacrimal Gland, Lacrimal Gland Imaging, Sarcoidosis
I. INTRODUCTION
Sarcoidosis is an idiopathic, multisystem disorder that can affect any organ system and is mainly characterized by pulmonary, dermatologic, and ocular involvement. Its pathological hallmark is non-caseating granulomatous inflammation. Ocular involvement has been reported by different studies at a rate of 25-60%. (1,2) Although anterior uveitis is the most common manifestation of ocular sarcoidosis, any orbital structure can be involved. Lacrimal gland involvement is the most common form of orbital sarcoidosis. (1,3)
Lacrimal glands are the most commonly involved structures of the orbit in orbital sarcoidosis. (3,4,5) The prevalence of lacrimal gland involvement varies across studies due to varying diagnostic criteria. Two large studies reported lacrimal gland involvement at rates of 7% and 15.8%. (2,6) Some studies based the diagnosis of orbital sarcoidosis on lacrimal gland enlargement and the presence of dry eye symptoms. However, sarcoidosis is a pathologic diagnosis, so a biopsy is recommended for a definitive diagnosis. Other relevant laboratory investigations revealed an elevated angiotensin-converting enzyme level/elevated levels of vitamin D/elevated calcium in the blood and urine.
The most common imaging finding is smooth, homogenous, diffuse and nearly symmetrical enlargement of the lacrimal glands bilaterally. Although tumors and infection can cause lacrimal gland swelling, they rarely do so bilaterally. Inflammation and infiltration are much more common causes of bilateral lacrimal gland swelling with sarcoidosis, lymphoma and leukemia being the prime differentials.(5) Diffusion