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Clinical Challenge
Radiology
May 2017

Recurrent Unilateral Swelling of the Parotid Gland

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Irvine Medical Center, University of California, Orange
  • 2Department of Otolaryngology–Head and Neck Surgery, University of Colorado, Boulder
JAMA Otolaryngol Head Neck Surg. 2017;143(5):521-522. doi:10.1001/jamaoto.2016.3714

A 45-year-old woman initially presented for evaluation of a 6-month history of intermittent left facial swelling and pain. She noted a discretely palpable mass in the left parotid region during these episodes. However, at the time of clinic presentation, she had no palpable masses on physical examination. Ultrasonography performed on the day of initial evaluation revealed no intraparotid masses, lesions, or stones. The patient was encouraged to return if she noticed acute return of swelling so that she could be evaluated when symptomatic. The patient returned days later with acutely worsening left facial swelling, which she noticed while straining. On presentation, she was diagnosed as having malignant hypertension and had a palpable parotid lesion noted on physical examination. When asked to perform a Valsalva maneuver, she was noted to have more pronounced left facial swelling (Figure, A). A short tau inversion recovery (STIR) image is shown in the Figure, B. Magnetic resonance angiogram was obtained (Figure, C and D).

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