 Hello, I am Dr. Ankita Jha Jr. resident at Krishna Vishal Vidyapet and I am here to have a paper presentation on ultrasound characterization of salivary gland lesions. The development of high frequency, high resolution linear transducers as a result of advancement in ultrasound technology transformed imaging of superficial structures. Ultrason can be used to examine most cases that present to the clinicians in their daily practice as neck or facial lumps and it can also aid in the imaging of salivary gland abnormalities. Our ability to make a solid diagnosis in this study was aided by the lesions morphological characteristic on ultrasound and the age of clinical presentation. The aim and objective of the study was to evaluate the role of ultrasound in detection and characterization of salivary gland lesions. A total of 100 patients were evaluated with suspected unsuspected salivary gland lesions. The patient would examine on GE Logic P9 color Doppler system with a high frequency linear array probe. Ultrason was performed in longitudinal and transverse axis with the help of the high frequency probe after clinical evaluating for the patient's chief complaints. Starting with the different cases that we have seen, the first case is a 15 year old female with history of painful swelling of bilateral parotid gland which increased after eating. On longitudinal study of the parotid gland we could see that it appears enlarged and there was few hypoepoic linear striations inside and generalized fat stranding around the parotid gland as well as the submandibular gland. This was indicated of a viral inflammation of the parotid. Here we have a 40 year old female with recurrent bounce of swelling over the left parotid region. An image C shows diffusely swollen parotid gland with paranchymal cysts and surrounding fat stranding showing multiple calcific foci within. This was suggested of a chronic paranchymal inflammation. In this case we have a 45 year old male patient with history of painful swelling of the left parotid gland with on and off history of fever. On longitudinal sonography the affected parotid gland appeared enlarged and showed multiple hypoechoic pockets within and there was increased vascularity on color Doppler studies. In images D and E as described this was indicative of multiple microapses of the parotid gland. Here we have a 30 year old male patient showing with the history of painful swelling of the right parotid gland with recurrent history of fever. On ultrasound we could see that the affected parotid gland appears hyper echoic enlarged and showed multiple small hyper-echoic circular oval lesions with the fatty hyalum within and appeared maintained and showed vascularity on color Doppler studies. This was indicative of a intra-parotid lymphotenopathy. In another case we had a patient with the history of lump in the right sublingual region since three months and on ultrasound we could see an ill-defined hetero-echoic predominantly hyper-echoic area in the right sublingual gland and an enlarged reactive lymph node adjacent to it. On further evaluation we could also see that the retromantibular vein and the facial vein appeared dilated showing echogenic content within with positive of color on color Doppler studies. All of these features were indicative of a thrombus secondary to the silent anitis within the gland. Moving on to the next cases we had a patient come with history of tenderness and swelling over the right parotid region with occasional episodes of fever. Here we can see the enlarged parotid gland showing hyper-echoic areas of necrosis within and it appears ill-marginated showing peripheral vascularity on color Doppler studies. This is further explained on this video we can see the ill-marginated hyper-echoic area within the gland. All of these were suggestive early abscess formation. Here we have a patient with a history of tenderness and swelling over the right submandibular region with on and off episodes of fever. On B mode of ultrasound we could see that the parotid gland actually was enlarged with hyper-echoic areas within and an enlarged cervical lymph node with maintained fatty hyalum adjacent to the gland probably because of the reactive inflammation and this was suggestive in early abscess formation. Here we have a 30 year old male who had complaints of tenderness over the right lateral aspect of neck with dysphagia and fever and on ultrasound we could see that the Walton's duct up here is dilated showing a hyper-echoic linear structure giving posterior caustic shadow within. This was suggestive of a submandibular calculus. Similar linear hyper-echoic structures were noted in the sublingual region giving posterior caustic shadowing and a dilated duct within the gland giving rise to a sublingual calculus. Here we have a 25 year old male patient who had come to ENT with history of recurrent painful swelling over the lateral aspect of the neck and associated difficulty in swallowing. In image A we can see a linear hyper-echoic structure giving the posterior caustic shadow within a dilated duct which is indicative of a calculus. But what we can see is in image B that is the adjacent parenchyma of the gland appears a hyper-echoic probably because of the concomitant inflammation arising from the calculus. In image C we can see we have a dilated duct with debris within indicative of a radial losing calculus. Here we have a 25 year old male patient who came with history of painful swelling over the left submandibular region below the angle of mandible and there was a history of swallowing of a fish bone while eating three days back. However the patient said that the fish bone did not come out. On ultrasound we could see in image A here a linear hyper-echoic structure within the gland and adjacent parenchyma shows mild inflammatory changes. Few subcentimetric cervical lymph nodes were noted surrounding the gland. All of these are suggestive of foreign body and its related inflammatory changes. The patient underwent left submandibular gland excision and it was concluded to be a fish bone. Here we can see the foreign body and the lymph node next to it here. Now we had a patient with complaints of dry eyes and mouth with bilateral parotid swelling. On V-mode ultrasound we could see that the parotid and submandibular glands showed multiple small hyper-echoic areas within and the thyroid gland appeared atrophic. However there was no evidence of calcification within the glands. These are consistent with intermediate stages of Georgian's disease. Here we have a 35-year-old male patient with a history of painless mobile lump over the right lateral part of the neck since two years. On grayscale ultrasound we can see a well-defined anechoic avascular lesion showing posterior caustic enhancement which is indicative of herangular. Another patient with a history of milds painful swelling which was slowly increasing in size with no history of fever in the sublingual region. On ultrasound we could see a multilocular tubular cystic structure in the left sublingual gland and it was also seen extending to the submandibular region. There were few hyper-echoic foci within this but there was no solid component or rascularity on color Doppler studies. This was indicative of a flunging granuloma. Here we have a 40-year-old male patient who had a swelling over the right parotid region after some dental work. On examination multiple cervical lymph nodes were palpable and the patient was subsequently tested and found to be HIV positive. On ultrasound a unilocular cyst was noted in the superficial part of the parotid with settled debris in the dependent portion. These features were suggestive of a lymphoepithemial cyst. Here we have a 45-year-old female who came with swelling in the left pre-oricular region. It was a solitary mobile non-tender swelling that gradually increased in size over six months. On investigation the patient had hyperglycemia and had a mygaloblastic anemic picture. On ultrasound we could see the enlarged hyper-echoic salivary gland with poorly visible deep lobe without any focal lesion or increased blood flow which indicated a benign salivary gland lesion. FNC was performed and it was concluded to be a siloasis. This was an incidental finding as the patient had come for USG neck for evaluation of dysphagia. Where we could see the right submandibular gland could not be appreciated, indicative of a genesis whereas the left submandibular gland appeared normal, showing compensatory hypertrophy. Here we have a 75-year-old male patient who was a known case of CA of the parotid gland and he had undergone radiation therapy and would come for regular follow-up. He was advised for ultrasound this time and we could see the affected parotid gland appearing smaller in size showing laws of normal architecture with reduced thickness which was due to post-radiation atrophy. Here we have a 30-year-old male patient who came with painless swelling of the left parotid region since five years with no history of sinus or discharge. On the longitudinal section of the parotid gland we can see a oval hyperbolic lesion with linear hyper-echoic structures within which is indicative of a subcapsular lipoma. In image B we can see that there is a well-defined lesion with similar characteristic as mentioned in image A but this is further within the parankyma indicative of an intra-parankyma lipoma. Here we have a 30-year-old patient who had a mobile lump in the right parotid region since five years with no history of sinus or discharge. On longitudinal section of the ultrasound we can see a well-defined oval heterochloric lesion with a sharp margin in the subcutaneous plane and it is seen pushing the parotid inferiorly which is indicative of a pre-auricular region dermoid or epidermoid cyst. Here we have a 40-year-old female with complaints of a painless lump over the right angle of the mandible. On ultrasound we can see here in image A that it is a well-defined hyper-echoic lobulated lesion with distinct borders giving posterior caustic enhancement in the parotid gland and on color-dopolis images we can see that there is increased vascularity surrounding the lesion. This is a typical appearance of a pleomorphic adenoma. Here we have a 60-year-old male patient with complaints of painless lump over bilateral parotid region. Image A shows the left parotid and image B shows the right parotid. So in image A we can see that there is a sharp marginated lesion in the left parotid with hypoechoic cystic areas within and it is giving us a typical posterior caustic enhancement and on the right parotid we can see a similar cystic-solid cystic lesion within and this is hyper-vascular on color-dopolis studies. All of these features are indicative of bilateral worth in tumor. Coming to the next case we have a 65-year-old male patient who came to the OMFS OPD with a history of painful lump in the pre-auricular region and it was associated with Trismis since six months and he was advised for ultrasound. On ultrasound we can see a homogeneous mass enlarging replacing most of the pattern chimera showing internal septations, plobulations and hyper-vascularity on color-dopolis studies. The patient underwent parodidectomy and on histopathology we could see that it was a mucoepidermal carcinoma. We have a similar case with a 65-year-old patient who came with a history of painful lump and Trismis in six months and on ultrasound we could see a solid cystic lesion replacing most of the pattern chimera of the parotid gland and showing a few necrotic areas within and appearing hyper-vascular on color-dopolis studies. He underwent a superficial parodidectomy and on histopathology we could determine that it was an adenoid cystic carcinoma. Concluding this study, ultrasound is an effective and practical technique for diagnosing disorders of the salivary gland. It not only makes it possible to confirm or rule out the existence of a mass but also on the basis of the ultrasound findings, the nature of the underlying disease may be frequently inferred. Using a high-resolution, high-frequency linear ultrasound imaging facilities, the assessment of the salivary gland morphomorphology aids in the routine clinical settings. A useful initial assessment for seeing salivary gland cancers is sonography. When sonography is unable to fully refine a lesion, we should opt for CT and MRI for further evaluation. Sonography is useful in confirming or ruling out abscess selectasia in cases of acute inflammation. It is usually the method of choice for diagnosing calculus and is better than plain films as it can also visualize non-opay calculus. Moreover, sonographic definition of the precise location is also possible. In our study, sonography not only identified advanced cases of autoimmune diseases as well as the persistent chronic inflammatory changes in salivary glands. In this study, as we can give a pictorial representation, most commonly presented conditions were acute cases of inflammation followed by benign tumors of the salivary gland and silolithiasis. These are my references. Thank you.