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Clinical Problem Solving: Radiology
February 2005

Radiology Quiz Case 1

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Copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2005

Arch Otolaryngol Head Neck Surg. 2005;131(2):178. doi:10.1001/archotol.131.2.178

A 54-year-old white man presented with a 3-month history of a left parotid mass. One month after the mass developed, facial paralysis occurred. At that time, the patient presented to his otolaryngologist. A fine-needle aspirate yielded 12 mL of clear nondiagnostic fluid. Of note, the facial paralysis resolved with drainage of the cystic mass. A T2-weighted gradient echo magnetic resonance imaging scan demonstrated a 4 × 3 × 4-cm well-defined, homogeneous lesion with increased signal intensity within both the deep and the superficial parotid lobe (Figure 1). Because clear fluid had been aspirated from the lesion, it was believed to be a cyst. At this point, the patient was referred for further evaluation. The rest of his medical history was unremarkable. He denied swallowing and speaking difficulties as well as constitutional symptoms. He was a nonsmoker who used ethanol socially. Physical examination revealed a soft, ballotable cystic mass in the tail of the left parotid gland. Cranial nerves II through XII were functioning normally. The facial paralysis had not returned since the initial aspiration of the mass. There was no evidence of parotid, cervical, or thyroid adenopathy.

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