 आप आप नहींसे तो आप छूँ वुप मेंने क्या पीकेंने थे? तो अगर भोगा मैंगा और लिए कचिए साचान करी सम्ऩात। तो आप याप छिएंगे कि थी ऱ्टिक वायी बगा आप आपका अप वोगये चिए चानी ये बी मुझे को रगते है तेज़ाभी दो ठा में ठीजी वैगी � next time you see it you got more confident that अरे यी ब़े नहीं कोगंटी के यी टाग्नोसीं suspere i by it looks like this लीड़न की मप्तकरट,ी लीट़न stereo मंिख तीसती है, बग� thrown मिशेज़ आनकंश्यशन से leavठ लिऊसी क्या कही मादू कि poor मैमरी बिनक अं। लासी मेघहा येड़षинов के लीढन Tú सिस्थह मप्स Terra मेंकषा क्वराश का लिठदरं की मुझद, फी переход का हणी okay ये अगर वीड़कचा आए पकुडाtzु। याई और पड़ा वीड़ना। आफ पूग्ग़ा वीड़ना। लए वोग़्िए नाचाण्टा। वोग़्ी। ये नदोमे त्रोमा पूग़्ट़। ये सिएं लिगने बघ़्दा। सोथा टेकिल नेख रप नेख योंगे मएं द़़ी जोब इंगे घेा रही है वाँत है, योंगे खाश मैंगद पंनागे... उगे खाश मेंगद योंगे योंगे बादगेगेगाचा एक औगी वॖत आगेपमगद वाँत पर करता है lump or he is gonna feel discomfort about it and he is gonna walk to your clinical suit talking about its application and the field of ultrasound again with high frequency linear transducer, you can evaluate these salivary glands especially parade its submandibular and give a reasonable diagnosis in most of cases if not understood again C T and m r and all are due to your rescue आ़ी बonda । apparition triksare simple अण्द बीचिन ढ़नी क। Any patient walks in ये की कोंक्कँम condem neck ये खाठन। History,histery and history यी इसरी के कोंभी � przeci- idiots So once you have localized space your diagnosis becomes very very easy so parotid gland parotid space and submandibular gland submandibular space so why i'm trying to stress is that if you look at the parotid space it has only five contents so it's the main gland per se the nerve retro mandibular vein external carotid artery and parotid always has lots of lymph nodes because of lymphoid tissue pathologies will always come from all these parts only so if you have parotid gland lesions they are going to look within the gland there is going to be nerve pathologies so there could be a neurogenic lesion coming from the facial nerve and lymph nodes which are ubiquitously seen in parotid imaging you cannot see facial nerve on ultrasound so how are you going to put it as a landmark because it's a very important landmark to the surgeon also so you're going to first search the vascular plane so what's the trick is that you're going to search for the retromandibular vein and the external carotid artery facial nerve lies bang above it whether you see it if you have a 16 megahertz you're very very lucky but if you're using 12 l3 12s which we commonly use in day to day practice you may not see a facial nerve it looks like a linear hyper echoic structure the importance of it is one is that it divides the parotid into superficial part and a deep part now mind you deep part of the parotid cannot be imaged on ultrasound so lesions which lie in the deep part are always always always only picked up on cd and mr so this landmark is very very important then the submandibular space there is this myeloid muscle where which divides it either into a sublingual space and a submandibular space very simple and supereo medial is sublingual and inferolateral is submandibular if you even memorize this much your life is going to be very very easy again contents in that submandibular space matter so again lymph nodes which are there anywhere you because it's a submandibular space there is going to be the superficial lobe of the submandibular gland facial nerve artery and the 12th nerve and fat so that's all are the contents of the submandibular space now you need to also always remember that parotid has ubiquitous intra parotid lymph nodes so many a times you could see a pediatric baby with lymphoid hyperplasia present to you and you might see those lymph nodes so now let's jump to cases and see how on pattern recognition we are going to pick up saliva religions so this young girl came to a clinic with swelling in the left submandibular region now when we started seeing the submandibular gland see this homogenous gland senior but see this linear hypoechoic areas so moment i saw this we know by our knowledge that this looks like to be multiple dilated ducts within the submandibular gland you should not leave this till either and then you should search where the water duct is going up to and see how beautifully you can see that there was a calculus sitting there so calculus can be picked up very nicely on ultrasound imaging and the dilated ducts pruning everything is so see beautifully on ultrasound then parotid gland similar pattern dilated ducts see such a large calculus seen in the stensins duct so you know how a calculus looks by now and you can make a confident diagnosis in practice you will see more of submandibular calculus as against parotid submandibular calculus or radiopic on imaging and ultrasound is a great tool to pick up those stones coming to inflammatory condition i was telling about this pediatric age group you see lot of lymph nodes in these parotid glands which enlarge and this condition is called as benign lymphoid hyperplasia now here you will see a gland which is full of these hypoechoic areas which are nothing but the nodes which get enlarged now a important echo the background of this gland is completely normal so when the background is normal pediatric age group lymph nodes enlarge this is benign lymphoid hyperplasia see this very beautifully you will see multiple hypoechoic areas seen within it in fact many a times you will see enlarge level to nodes within the neck so putting two and two together you can say it as a lymphoid hyperplasia then the most common has seen in day-to-day practice is silent anitis so patient is going to present with pain swelling so you the gland is going to look enlarged it's going to look heterogeneous if you put Doppler it's going to look vascular there is going to be typically level to nodes jugular digestic nodes and when you have an history in setting and you're going to write it as acute silent now here the most commonly in practice what we see is parotid involvement in silent anitis which is most commonly bacterial now the causes could be huge the organisms are multifactorial but what's more important is always follow up cases of silent anitis because they are prone to secondary complications like formation of an abscess and they usually have sometimes even painful cervical nodes which enlarge and supure it so always always ask for a follow-up in all cases of silent anitis viral infections also can affect the glands where typically there is bilateral involvement there are level to nodes and even they can undergo secondary complications in terms of abscess formation how do you see you have typically a child with mumps diagnosed by the clinician how you see it on imaging you will see this typical rounded rounded spots all involving the parotid glands sometimes even the submandibular glands and that is the characteristic of a viral silent anitis then sometimes in pediatric age groups there are suppurations of the lymph nodes and these lymph nodes become so liquefied and across it that they form a large lymph nodal mass and this can also present to you as a painful love and these necrotic nodes with an supurated lymph nodal mass you need to tell the clinician or the surgeon two things one whether these lymph nodes have completely gone under supuration because then it is only amenable to surgical excision but if not they are put on high dose antibiotics and patient is then asked for a follow-up sometimes they settle with good heavy antibiotics but if not then they have to be excised in fact at times there is something called as pan-silodonitis where submandibular parotid everything gets involved badly inflamed glands and you will see lot of vascularity on imaging patient with severely toxic pain fever putting two and two into picture of a clinical scenario you can write this diagnosis of a pan-silodonitis then chronic inflammatory conditions involving the salivary glands you all know of jograns so it's going to be a classical of 40 or a 50 year old female typically presenting with keratoconjunctivitis sika dry eyes dry mouth so see how important is history here you are always going to do imaging of the parotid and submandibular glands but what is your intention of doing this imaging one is to rule out salivary gland involvement of a jograns but the most most important take home that jograns cases parotid lymphomas are very very highly associated so your job as an imaging specialist says to his rule out an associated lymphoma with jograns so again see how this looks doesn't it looks typically like the silodonitis but here there is a female with a dry eyes dry mouth syndrome and typically hypoequic spots seen all around the parotid glands with an in background history you are going to report it as a jograns involvement of parotid gland so the spectrum of looking of these morphologies is same silodonitis with pain swelling fever then lymphoid hyperplasia the way i showed you the third thing is this condition called jograns but with a female and a background history known to you you can make a confident diagnosis of a jograns involvement of parotid 20 days back we had a sarcoidosis involving the liver and in those patients also submandibular gland involvement of sarcoidosis is known in fact they have seen that glands look normal but if you do histopathology of those glands in most of the cases you will see sarcoid elements in the submandibular glands cox in india can be anywhere and everywhere now how this cox is going to affect salivary glands is in two ways one within the parankaima itself or periparotid for example the area around the parotid gland and that can cause a very confusing flick picture so primary tb involving the salivary glands is quite rare but the secondary ones are very very common and they can typically involve a submandibular or a submandibular glands now what are you going to see is you are going to see a dirty collection with internal ecos cavities now it might be very technically difficult for you to distinguish it from an abscess but a cold abscess you need to do an fna or biopsy to rule out the same so see this case which was a huge collection the t-cos seen within the submandibular glands and see it had completely eroded the mandible can you appreciate this see how beautifully on ultrasound you can pick up these erosions and this was cox