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Clinical Problem Solving: Radiology
October 2004

Radiology Quiz Case 2

Author Affiliations
 

R. NICKBRYANMDPATRICIA A.HUDGINSMD

Arch Otolaryngol Head Neck Surg. 2004;130(10):1237-1238. doi:10.1001/archotol.130.10.1237

A 58-year-old Chinese man presented with a 7-year history of prominent soft tissue swellings in the head and neck region. On examination, a 3.0 × 2.5-cm soft mass was palpable in the tail of the right parotid gland, causing displacement of the ear. There was also a 2.0 × 1.5-cm lymph node in the right jugulodigastric area and another soft mass (4.0 × 2.0 cm) superficial to the left masseter muscle. A chest x-ray film demonstrated no abnormalities. The Figure 1 shows the right parotid mass, with involvement of the overlying skin, and the lesion superficial to the left midmasseter muscle. One year earlier, a similar lesion had been removed from the patient's left submandibular triangle, followed by a small palpable recurrence. Interestingly, when the submandibular mass was removed, the other lesions increased in size but stabilized with a 5-day course of oral prednisolone (30 mg/d). The patient is currently on an oral regimen of prednisolone (5 mg/d) to control the disease process. Previous blood tests revealed eosinophilia and elevated levels of IgE.

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