Presentation
Right parotid swelling following dental work.
Patient Data
3cm unilocular cyst within the right parotid gland with some internal debris and suggestion of a small peripheral nodule at the deep aspect. Multiple small sub 5mm hypoechoic lesions are seen elsewhere within the gland, with several showing discrete solid nodular components.
The 3cm cystic lesion seen on ultrasound is shown to be T2 hyperintense with intermediate T1 signal. Inferiorly within the right parotid gland there is a 12mm mixed solid cystic lesion. In both parotid glands there are multiple small round or ovoid T2 hyperintense lesions most of which enhance similarly to parotid parenchyma, however several of which do not enhance suggestive of small cysts. The palatine and lingual tonsils appear prominent as do many of the cervical lymph nodes suggesting lymphoid hyperplasia. Normal appearing submandibular glands.
Case Discussion
3 cm unilocular cystic lesion within the superficial portion of the right parotid gland. This contains a small amount of debris on the ultrasound images and is of homogeneous high T2 signal and of intermediate T1 signal.
12 mm mixed solid cystic lesion inferiorly in the right parotid gland. Multiple other small less than 5 mm lesions within the bilateral parotid glands some of which are cystic and others of which are more compatible with intra-parotid lymph nodes.
Features of lymphoid hyperplasia with enlargement of the palatine and lingual tonsils and prominent cervical lymph nodes.
The appearances are suspicious for HIV infection with benign lymphoepithelial lesions of the parotids and lymphoid hyperplasia. The larger cyst debris and intermediate T1 signal is perhaps the result of recent hemorrhage.
Sjogren's disease would be the major differential diagnosis however the patient gender and normal appearance of the submandibular glands make this less likely.
This patient was subsequently tested and found to be HIV positive.