Parotid abscess

Diffuse skin and subcutaneous fat planes thickening with stranding as well as diffuse enlargement and edema of left parotid gland. It has an ill-defined hypodense area related to deep aspect of the superficial lobe. The lesion shows streaky irregular outlines and central area of low density (collection) causing posterior enhancement. The lesion measures about 2.8 x 1.5 cm in diameter.  A reactionary multiple enlarged cervical and submandibular reactionary lymph nodes are noted. The picture of diffuse left side parotitis with area of low echogenicity as described likely represents parotid abscess formation.

Three days later CT done and shows a large cavitary lesion is seen affecting mainly the superficial lobe of the left parotid gland and reaches to the deep lobe. It has heterogeneous peripheral enhancement. It involves and enlarging the left medial pterygoid and masseter muscles with posterolateral displacement of the left sternocleidomastoid muscle. The inflammatory lesion is effacing the left parapharyngeal fat without significant compromising the related airway. The lesion enlarges and measures 6.4 X 5.7 X 9.4 cm in maximal dimensions with tiny air foci noted within. A radio dense drainage tube is noted abutting the lateral surface of the lesion and noted in the related significantly thickened subcutaneous tissues. Subcutaneous fatty stranding with skin thickening seen involving mainly the left aspect of the face and neck.Multiple enlarged bilateral cervical and submental lymph nodes, mainly on the left side at multiple levels.