Presentation
Presents with 5 day history of increased erythema and swelling to right cheek.
Patient Data
Between the superficial and deep lobes of the parotid in the hypodense, faintly rim enhancing collection, displacing parapharyngeal fat medially and anteriorly. Stranding is seen extending into the parapharyngeal and overlying subcutaneous fat.
The imaging appearances are suggested of a parotid abscess or necrotic parotid mass.
The primary clinical diagnosis was parotid abscess. The patient was referred for ultrasound +/- aspiration.
In the superficial parotid lobe there is a well-defined round mixed solid/cystic lesion. It is slightly compressible, and is tender. Equivocal internal vascularity. Normal intraparotid lymph nodes are noted.
Sterile technique. Under ultrasound guidance the cystic component was targeted and small volume of pus was aspirated. The solid areas were targeted for a further 3 x 25G FNAs.
RIGHT PAROTID MASS FNA
MICROSCOPIC DESCRIPTION: The smears are moderately cellular with occasional groups of oncocytes. Most of the epithelial cells are degenerate and necrotic with squamoid appearance. They show no nuclear atypia. The background contains abundant lymphocytes and cellular debris. No malignant cells are identified.
DIAGNOSIS: FNA right parotid mass: Warthin tumor.
CULTURE
1. Burkholderia cepacia complex +++
Case Discussion
Warthin tumors are the second most common tumor of the parotid gland. In this case, the ultrasound appearance of a mixed solid/cystic mass is not typical for the working diagnosis of a parotid abscess nor of the differential on imaging of a necrotic mass. Selective targeting of different components (cystic) and solid was vital to making the diagnosis.
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