Presentation
Presented with left facial swelling and fever for 5 days.
Patient Data
The left parotid gland is enlarged as compared to the right parotid gland, with heterogeneous enhancement. There is a multiseptated, multiloculated, peripheral rim-enhancing collection with a low-attenuating component seen at the superficial lobe of the left parotid gland. No air locule or internal calcification. It is associated with thickening of the left platysma, ill-definition of the left masticator muscle, left pinna oedema, and surrounding fat streakiness. The overlying skin is thickened. No adjacent bony erosion is noted.
Fat streakiness is seen in the left parapharyngeal and left masticator spaces.
Both tonsils are enlarged (left more than right), suggestive of tonsillitis which is causing narrowing of the oropharynx. Adenoidal hypertrophy is present.
Note cervical lymphadenopathy, largest lymph node is at left level IIb measuring 1.2 cm in SAD.
Case Discussion
This is a case of left parotitis with left parotid abscess and cervical lymphadenopathy.
The patient was treated with intravenous (IV) antibiotics and proceeded for aspiration of the left parotid abscess. 3cc of pus was aspirated. Pus culture and sensitivity were negative and no AFB was detected in the sample. His clinical condition has improved and he was discharged well.
Correlating with the clinical history of fever, raised C-reactive protein (40.9 mg/L) and response to IV antibiotics, the cause of parotitis is most likely secondary to infection.
The most important clinical aspect to remember for a patient, especially children presented with parotitis, more so for recurrent parotitis is the possibility of the congenital first branchial cleft anomaly. MRI would be a useful imaging modality to look for any possible tract to the external auditory canal in recurrent parotitis.
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