Acute viral parotitis

Case contributed by Dr Guilherme P. Stangler

Presentation

5-year-old girl brought to the E.R. with painful swelling of the right side of her face. The mother also complained about fever (38.6ºC) and dry cough in the last 48 hours.

Patient Data

Age: 5-year-old
Gender: Female
Ultrasound

In this US image of the right parotid gland it is possible to see a markedly heterogeneous pattern of the gland, with several hypoechoic round images permeating its parenchyma. These round images proved to be prominent vessels on the color Doppler ultrasound. An image of the left parotid gland of the same patient is available for comparison of size, echogenicity and vascularization.

Case Discussion

The parotid glands are small exocrine glands located superficial and around the ramus of the jaw, which are rarely affected by diseases of any kind. Occasionally, however, the radiologist is asked to examine them (usually in the setting of pain or swelling).

In children, the main cause for painful enlargement of the parotid is an entity called viral parotitis, usually caused by Mumps. This paramyxoviral disease is spread by droplets or direct contact, and its prevalence has drastically decreased since vaccination started in the 1970's, being more common in underdeveloped countries. The children may present viral symptoms like fever, dry cough and body pain, but a dominant feature may be the viral parotitis, which appears in the US as heterogenicity of the parenchyma with augmented vascularization.

Differential diagnosis includes acute bacterial parotitis, HIV parotitis, parotitis related to tuberculosis, Mickulicz disease, Sjögren's syndrome, sialolithiasis, chronic recurrent parotitis, sarcoidosis, benign tumors and malignancy.

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Case information

rID: 43626
Case created: 19th Mar 2016
Last edited: 16th Nov 2017
Inclusion in quiz mode: Included

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