Phleboliths – a rare differential diagnosis in obstructive sialopathy

Introduction The most common cause of recurrent swelling of the major salivary glands is sialolithiasis. An extremely uncommon differential diagnosis of a clinical presentation of an obstructive sialopathy by a phlebolith, which compresses the salivary duct.

Case Report A 55-year-old female presents herself with a recurrent swelling of the left cheek for half a year. There are not relevant secondary diagnosis and no rememberable traumata in history. In clinical examination the palpation shows a sturdy concretion. The ultrasound shows the stereotype of a sialolithiasis with a hyperechoic concretion and posterior attenuation, though missing dilatation of the duct, vascular malformation or signs of sialopathy. Due to an unsuspicious sialendoscopy the concretion was detected upon palpation and was intraorally removed after slitting a vein. The histopathological result showed clear signs of a phlebolith. Since the operation the patient is symptom-free.

Discussion Up to date less than 30 cases describe phlebolits in the facial area. Still, the development of phleboliths with unknown origin, and in particular without a vascular malformation extremely rare. Due to the posterior attenuation in the ultrasound, a phlebolith is depending on its position hardly distinguishable from a sialolithiasis. Therefore, when conducting a sialendoscopy, especially if there is no calculus detectable, palpation should always be performed not to oversee other pathologies like phlebolits.

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Artikel online veröffentlicht:
12. Mai 2023