Clinical Problem Solving: Radiology
February 2013

Radiology Quiz Case 1

Author Affiliations


JAMA Otolaryngol Head Neck Surg. 2013;139(2):187. doi:10.1001/jamaoto.2013.1275a

A previously healthy 63-year-old woman presented with a 2-year history of gradual, painless enlargement of the right parotid gland. She denied fever, weight loss, or malaise. There was no indication of cough or shortness of breath. There was no complaint of trismus. Physical examination revealed a palpable, mobile mass in the right parotid region. The mass was nontender and nonfluctuant, without obvious inflammatory changes in the overlying skin. There was no evidence of facial nerve paralysis. The findings of examination of the oral cavity, including the Stensen duct orifice, were normal. The results of routine laboratory investigations and radiography of the chest were normal. The patient was admitted for further investigation and treatment of a suspected tumor of the parotid gland. A contrast-enhanced computed tomographic scan of the neck demonstrated a 2.8-cm cystic or necrotic mass confined to the superficial right parotid gland (Figure 1 and Figure 2). The lesion had a relatively well-defined, smooth margin with an enhancing wall of variable thickness. Posteriorly, the wall demonstrated focal thickening and nodular enhancement (Figure 2, arrow). No calcifications were present. There was no extension to the deep lobe, the masticator space, or the overlying skin. The left parotid gland was normal. Mild nonspecific bilateral cervical adenopathy was also identified.

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