Annals of Emergency Medicine
Volume 58, Issue 6 , Pages e5-e6, December 2011

Unilateral Facial Swelling With Fever

  • Casey A. Grover, MD

      Affiliations

    • Stanford/Kaiser Emergency Medicine Residency, Stanford, CA
    • ,
  • Laleh Gharahbaghian, MD

      Affiliations

    • Division of Emergency Medicine, Stanford University, Stanford, CA

Article Outline

 

[Ann Emerg Med. 2011;58:e5-e6.]

A 3-year-old fully vaccinated girl presented to the emergency department with a 2-day history of low-grade fevers, runny nose, and a “swelling” on the left side of her face. Physical examination demonstrated a well-appearing child with a firm, mobile, 2-cm swelling over the angle of the left mandible. Ultrasonography of the swelling was performed with a 5- to 10-MHz linear array transducer probe (Figure 1). For comparison, ultrasonography of the same area on the right side was performed (Figure 2).

  • View full-size image.
  • Figure 2. 

    Ultrasonography of the corresponding area on the patient's right side, for comparison, demonstrating decreased tissue mass and less prominent hypoechoic areas as compared to the left side.

Used with permission of Casey A. Grover, MD, Stanford/Kaiser Emergency Medicine Residency, Stanford, CA.

Back to Article Outline

Diagnosis 

Parotitis 

Acute parotitis may be caused by a variety of infectious agents, including paramyxovirus (mumps), Coxsackie virus, cytomegalovirus, and Staphylococcus aureus.1, 2 Although history and physical examination are helpful in the patient suspected of having parotitis, the superficial location of the parotid glands makes them amenable to ultrasonography. Ultrasonography is well established as being able to evaluate the parotid gland, particularly in excluding malignancy and abscess as the cause of parotid enlargement.1, 3

The normal parotid usually appears homogeneous and is more echogenic than the surrounding muscle.1 Small hypoechoic areas may be observed in a normal parotid gland.3 When acutely inflamed, the gland enlarges and appears heterogenous.1 Hypoechoic areas in the superficial lobe of the parotid may be more prominent in glands affected with parotitis.4

Back to Article Outline

References 

  1. Howlett DC. High resolution ultrasound assessment of the parotid gland. Br J Radiol. 2003;76:271–277
  2. Patel A, Karlis V. Diagnosis and management of pediatric salivary gland infections. Oral Maxillofac Surg Clin North Am. 2009;21:345–352
  3. Lamont JP, McCarty TM, Fisher TL, et al. Prospective evaluation of office-based parotid ultrasound. Ann Surg Oncol. 2001;8:720–722
  4. Nozaki H, Harasawa A, Hara H, et al. Ultrasonographic features of recurrent parotitis in childhood. Pediatr Radiol. 1994;24:98–100

 For the diagnosis and teaching points, see page e6.

 To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com.

PII: S0196-0644(11)00716-5

doi:10.1016/j.annemergmed.2011.06.017

Annals of Emergency Medicine
Volume 58, Issue 6 , Pages e5-e6, December 2011

Article Tools

* Image Usage & Resolution