Presentation
4 day history of of progressive left parotid swelling on a background of left sialadenitis
Patient Data
Dilatation of the left parotid duct is demonstrated. The previously noted calculus is less well delineated on current MRI sequences but likely corresponds to an ovoid area of low signal posterior to the facial vein, immediately prior to piercing buccinator.
The region of tapering/occlusion of the left parotid duct is well anterior to the parotid gland, corresponding to the anterior edge of the left masseter muscle complex.
The peripheral, extra-parotid facial nerve branches are beyond the resolution of MRI.
Multiple bilateral minimally enlarged cervical lymph nodes noted - likely inflammatory.
Conclusion:
The left parotid duct is dilated, the previously documented calculus less well visualized on MRI.
The left parotid duct is significantly dilated measuring up to 8 mm in width.
There is a significant amount of fat stranding in the left masticator and parotid spaces extending inferiorly into the neck and superiorly to the temporal fossa. The left parotid gland is bulky when compared with the right.
An 8 mm x 4 mm calculus is identified in the parotid duct.
There are multiple enlarged cervical lymph nodes along the internal jugular and spinal accessory chains bilaterally, worse on the left. The largest left internal jugular node is seen at level 2 and measures 1.6 cm x 1 cm.
Soft tissue stranding and swelling extending from the deep parotid space into the left parapharyngeal space causes mild compression of and deviation of the oropharynx to the right without evidence of adjacent collection.
No evidence of osteomyelitis. Metallic dentalware causes marked streak artifact.
Conclusion:
8 mm obstructive parotid duct calculus with marked parotid duct dilatation.
No collection.
Case Discussion
Key learning points:
1. Calculi are easier to see on CT.
2. The parotid duct lies posterior to the facial vein in the cheek.
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