Presentation
A known HIV-positive patient presents with progressive, painless, parotid enlargement. Imaging request to assess the cervical soft tissues and salivary glands.
Patient Data
Contrast-enhanced CT imaging confirms features consistent with benign lymphoepithelial lesions of the parotid and submandibular glands. This is demonstrated by significant parotomegaly, diffuse, bilateral, solid and ill-defined cystic salivary gland masses predominantly involving the parotid glands and to a lesser extent the submandibular glands. There are shotty anterior and posterior cervical chain lymph nodes and nasopharyngeal lymphoproliferative hyperplasia consistent with known HIV and immune suppression.
Case Discussion
The salivary gland appearance above can be characteristic of autoimmune disorders such as Sjogren's syndrome and Mikulicz syndrome or due to HIV and immune suppression.
There is a honeycomb or salt (fat) and pepper (calcium) appearance on MRI due to a combination of fat deposition, calcifications and cystic (ring enhancing) lesions. The above case illustrates the CT equivalent appearance due to solid and cystic lesions that enlarge the salivary glands in HIV-positive patients.
In this specific patient, lymphoma and opportunistic and atypical infections are further excluded.