A 13 year old female with complaints of recurrent swelling with on and off pain in left cheek for 7 years, 5-6 episodes/year. Pain on chewing also present.
On examination: Enlarged and tender left parotid gland.Extrusion of air bubbles with saliva on Stenson’s duct massage.
A. FINDINGS - MR SIALOGRAM
B. FINDINGS - MR SIALOGRAM
A. LEGENDS:
- Multiple dilated intraglandular ducts.
- Multiple tiny air fluid levels within some dilated ducts.
B. LEGENDS:
- Bulky left parotid gland.
- A 11x 7 mm abscess in the left parotid tail.
- Normal right parotid gland.
DIAGNOSIS:
- JUVENILE RECURRENT PAROTITIS WITH PAROTID ABSCESS.
- NO OBSTRUCTION.
DISCUSSION:
INTRODUCTION AND ETIOLOGY:
- Non-obstructive, non-suppurative parotid inflammation in children
- Second most common salivary gland disorder after mumps
- Onset: 3–6 years; self-limiting with spontaneous resolution
Multifactorial etiology:
- Congenital ductal anomalies
- Recurrent infections or immune immaturity
- Allergic, autoimmune, or genetic predisposition
- Decreased salivary flow or poor drainage
CLINICAL FEATURES AND DIAGNOSIS:
- Episodic parotid swelling: unilateral or bilateral Pain, mild fever; no purulent discharge
- Duration: 2–7 days; episodes recur several times a year
- Diagnosis:
- Ultrasound: punctate hypoechoic areas (sialectasis)
- MRI sialography: T2W hyperintense ducts, better ductal mapping
- Rule out: Sjogren’s, HIV, mumps, tumors
MANAGEMENT AND PROGNOSIS:
- Conservative (mainstay):
- Warm compresses, hydration, analgesics
- Sialogogues, massage, oral hygiene
- Acute phase: analgesics ± antibiotics (if superinfection)
- Interventions:
- Sialendoscopy: duct irrigation, steroid instillation
- Surgery: parotidectomy rarely needed
- Prognosis: improves with age; often resolves by adolescence
REFERENCES:
- Gleeson M, et al. Scott-Brown’s Otorhinolaryngology, 8th ed.
- Leerdam CM, et al. Int J Pediatr Otorhinolaryngol. 2005;69(6):709–716
- Nahlieli O, et al. J Oral Maxillofac Surg. 2004;62(3):294–298
- Fauroux MA, et al. Radiology. 2013;269(2):602–608
- Becker M, et al. Eur Radiol. 2008;18(11):2376–2383
DR. ANITA NAGADI
SENIOR CONSULTANT RADIOLOGIST,
MANIPAL HOSPITAL, YESHWANTHPUR
DR. FATHIMATH ASHILI KM
RADIOLOGY RESIDENT,
MANIPAL HOSPITAL, YESHWANTHPUR