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Clinical Problem Solving: Radiology
May 2003

Radiology Quiz Case 1

Author Affiliations


Arch Otolaryngol Head Neck Surg. 2003;129(5):594. doi:10.1001/archotol.129.5.594

A 21-YEAR-OLD MAN presented with a long history of ear discharge that mimicked external otitis media and and a 6-month history of an ipsilateral parotid gland mass. He had no other cranial abnormalities, no hearing loss, and no history of surgery or trauma.. His medical history was unremarkable. He was using several medications, including oral antibiotics and ear drops for the otitis externa. Otoscopy of theright ear showed a healthy tympanic membrane and generally healthy external auditory meatal skin, except for a fistula opening on the inferior wall, just anterior to the eardrum, which was only evident on endoscopic evaluation (Figure 1 [EAC indicates external auditory canal; F, fistula; and TM, tympanic membrane]). The findings of conventional otoscopic examination were unremarkable. Computed tomography of the neck mass demonstrated a well-demarcated lesion located superficial to the parotid gland and an abnormal structure of the bony auditory canal (Figure 2, arrow). Radiographic analysis of the tract after injection of contrast material in the ear canal confirmed a cyst (Figure 3, arrow). The patient underwent excision of the salivary cyst and a superficial parotidectomy. The salivary opening of the tract was sealed with tragal cartilage, temporalis facia, and fibrin glue. Histopathologic analysis of the surgical specimen revealed chronic sialoadenitis. There was no evidence of tumor. The patient's postoperative recovery was uneventful, and he has been symptom free for 6 months.

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