Wk 9, Case 1 - Review

Patient History
Chronic sialadenitis.

Findings
Pre- and postcontrast MR was performed of the brain and parotid gland.

Brain: Sagittal T1-weighted images demonstrate corpus callosum to be intact. No evidence of Chiari malformation. No abnormal pineal region masses. Pituitary gland is not enlarged. Diffusion imaging demonstrates no evidence of recent infarct. Gradient-echo imaging shows no evidence of hemosiderin staining. Axial FLAIR and T2-weighted images demonstrate few scattered areas of increased signal in the juxta cortical, centrum semiovale and periventricular white matter. No evidence of vasogenic edema or mass effect. No abnormal intra-axial or extra-axial enhancing masses.

Parotid Gland: Pre- and postcontrast MRI of the parotid gland demonstrates an approximately 3.1cm x 1.7cm mass involving the superficial lobe of the parotid gland. The superior aspect of the mass extends into the pretragal portion of the left parotid gland. Inferiorly, the mass extends to approximately the midportion of the parotid gland. The lesion appears to involve the superficial lobe as it is lateral to the left retromandibular vein. This mass is predominantly high signal on T2, intermediate signal on T1, and enhances with contrast. The mass extends laterally to abut the paratidomasseteric fascia. No definite evidence of enlarged cervical lymph nodes given standard size criteria is identified in the visualized portion of the neck. Bilateral mucosal thickening involving alveolar recesses of maxillary sinuses. Visualized portions of the nasopharynx, oropharynx, oral cavity and hypopharynx are within normal limits.

Conclusions
1. Approximately 3.1cm x 1.7cm enhancing mass involving the superficial lobe of the left parotid gland. The most likely diagnosis is pleomorphic adenoma especially if the facial nerve is intact. Other minor salivary glands cannot be fully excluded. On rare occasions, chronically infected developmental cyst can have a similar appearance, however, this would be unusual in this case.
2. No abnormal intra-axial or extra-axial enhancing masses.
3. Few scattered white matter hyperintensities likely due to nominal gliosis in this age.