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Clinical Challenge
August 2015

Left Parotid Gland Swelling in an Infant

Author Affiliations
  • 1Department of Otorhinolaryngology–Head and Neck Surgery, Weill Cornell Medical College, New York, New York
JAMA Otolaryngol Head Neck Surg. 2015;141(8):765-766. doi:10.1001/jamaoto.2015.0963

An infant girl presented to the pediatric otolaryngology clinic with a 2-month history of an enlarging left preauricular mass. The parents first noticed a pea-sized nodule in front of her left ear that was now 3 cm, soft, mobile, and nontender, without overlying skin changes or facial nerve impairment. The infant was otherwise well without fevers, feeding well, and growing appropriately. Her mother had a full-term vaginal delivery without complications and a medical history that was notable only for gastroesophageal reflux disease treated with ranitidine. Ultrasonography showed a 2.2 × 3.0-cm solid nodule. The patient was then referred for magnetic resonance imaging (MRI) with contrast, which showed a 2.9 × 1.6 × 2.3-cm mass with a well-defined capsule arising from within the superficial left parotid gland. The mass was largely of fat signal intensity on both T1-weighted (Figure, A) and T2-weighted sequences with heterogeneous soft-tissue enhancement on T1 post-contrast (Figure, B). The mass also suppressed relatively uniformly on short T1 inversion recovery (STIR) sequence (Figure, C). The Figure, D, shows the mass in situ during surgical excision with facial nerve monitoring.

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