5)Parotid Gland – Different faces behind the mask – MRI based Two case review

  [3] RAD-TIMES -- VOLUME 1-- ISSUE 3

3) Parotid Gland – Different faces behind the mask – MRI based Two case review

By Dr Kushal Bidichandani (Senior Resident) , Dr. Salman Mapara (Senior Resident) and Dr Prashant Mudaliar (Fellow).

Lokmanya Tilak Municipal Medical College and General Hospital, Sion Mumbai 400 022

Introduction :-  

 

Case 1: – A 50 year old Female patient presented with bilateral peri-auricular region painless swelling.  No H/o dryness of mouth. On serology the patient was tested ELISA positive for HIV antibodies, all other investigations were within normal limits.  

MRI Parotid reveals –


Figure 1{A}, 1{B} reveals – Multiple lobulated well defined T2 /  STIR hyperintense and T1 hypointense cystic lesions in the mildly bulky bilateral parotid glands with maintained architecture of the gland.
Figure 2 reveals – T1 FS PC isointense cystic lesions with peripherally enhancing walls.

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Diagnosis :- Benign Lympho-epithelial Cyst (BLEC). [FNAC follow up of patient was taken which was consistent with the MRI diagnosis of Benign Lympho-epithelial Cyst (BLEC).]

Benign Lympho-epithelial Cyst (BLEC) is the occurrence of the single or multiple cysts in the parotid gland lymph nodes. They usually presents as painless swelling in the bilateral parotid gland region with no signs of inflammation in HIV positive individuals. MRI usually helps in diagnosis which reveals multiple T2 / STIR hyper intense and T1 hypo intense lesions with mildly enhancing walls in bilateral parotid glands.

Case 2: – A 63 year old Female patient presented with bilateral peri-auricular region pain and swelling with H/o dryness of mouth. On serology the patient was tested positive for anti Ro and La antibodies, all other investigations were within normal limits.  

MRI Parotid reveals –

Figure 1{A}, 1{B} reveals – Multiple tiny well defined  STIR hyperintense and T1 hypointense signal cysts giving a “Salt & Pepper appearance” are noted scattered in the bilateral mildly bulky parotid glands with loss of normal signal intensity of the gland.
Figure 2 reveals – STIR coronal reveals reveals atrophied bilateral submandibular glands with fatty infiltration.

Diagnosis: – Sjogren Syndrome.

Sjogren Syndrome is an autoimmune disorder which affects the salivary glands especially the parotid glands and presents as a triad of – xerostomia, conjunctivitis sicca and other associated autoimmune disorders. Patients usually presents with bilateral parotid region swelling with dryness of mouth and difficulty in chewing. MRI usually helps in diagnosis which reveals multiple tiny T2 / STIR hyperintense and T1 hypointense cysts noted scattered throughout the bilateral parotid gland parenchyma with loss of normal signal intensity.

Location: Mumbai, Maharashtra, India

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