Radiology Quiz Case 3

Abstract

A 30-YEAR-OLD MAN PRESENTED WITH A long-standing history of bilateral, intermittent facial pain and swelling. He recalled multiple episodes of these symptoms occurring intermittently each year since he was 8 years old. The episodes included bilateral pain and swelling over the cheeks and preauricular areas that typically lasted for hours to days. In addition to the pain and swelling, he stated that during certain episodes he noticed an audible sound of “wind” when he massaged or pressed the area in front of his ear. The number of episodes had increased over the past year, and he had been seen by a primary care physician and an otolaryngologist for his symptoms. The findings of previous imaging had appeared normal according to the patient, and he had been treated with oral antibiotics during previous episodes. He had no history of trauma or dental problems. He had a 15 pack-year history of smoking and occasional alcohol use. He denied weight loss and chronic fevers and had received all childhood immunizations. On physical examination, the areas over the parotid gland and preauricular soft tissue appeared to be full to the touch and tender on both sides, with no erythema noted. Oral cavity examination showed frothy saliva coming from each parotid duct during palpation over the ipsilateral aspect of the cheek, but no purulent drainage. Further palpation over the left parotid gland elicited an audible sound that can be described as a release of gas. A computed tomogram was obtained 2 days after consultation (Figure 1 and Figure 2). What is your diagnosis?