Presentation
Recurrent preauricular fullness and dyscomfort. Parotitis?
Patient Data
In the left, symptomatic parotid multiple 2-5 mm reflective foci are visible. These could be mistaken for stones, and indeed this was my first thought, however the marked ring-down artifacts and color reverberations udnerneath these areas are highly unusual.
Discussing the issue with the patient it was revealed that recently she was habitually blowing up the left cheek to reduce irritation caused by a slowly healing but benign apthous ulcer, which coincided with the beginning of the symptoms. She also told that this maneuver increases the feeling of fullness. The patient demonstrated this by puffing her cheek, which resulted in an increased amount of such foci on US.
The contralateral parotid and rest of the imaged structures were normal.
Note: the body mark position is incorrect on the cine loops.
Case Discussion
Prolonged, high intraoral pressure due to any reason (trumpet players, glass blowers, etc.) can result in pneumoparotid. This is a somewhat unusual, unilateral presentation which correlated well with the history provided, and likely resulted partially from dysfunction of the Stensen duct. Manual compression of the left parotid even produced a crackling sound.
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