This Article Abstract Full Text Full Text (PDF) Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Howlett, D C Search for Related Content PubMed PubMed Citation Articles by Howlett, D C

High resolution ultrasound assessment of the parotid gland

Consultant Radiologist, Radiology Department, Eastbourne District General Hospital, Kings Drive, Eastbourne, East Sussex BN21 2UD, UK

View larger version (97K): [in a new window]   Figure 1. Longitudinal section through the right parotid gland which demonstrates the homogeneous and hyperechoic nature of the gland texture. The intraparotid vessels are well demonstrated with the retro-mandibular vein (long arrow) lying superficial to the external carotid artery (curved open arrow). Note the mandible (arrowhead).

View larger version (77K): [in a new window]   Figure 2. Transverse section through the tail of the left parotid gland demonstrates a typical normal, intraparotid node (short arrow). Note the prominent central, hyperechoic hilum and also linear, hyperechoic intraparotid ducts (long arrow).

View larger version (115K): [in a new window]   Figure 3. Longitudinal section through the left parotid gland demonstrates a typical pleomorphic adenoma (callipers) which is homogeneous, hypoechoic and well circumscribed with distal acoustic enhancement. This can be seen to lie superficial to the retro-mandibular vein (arrow) and hence in the superficial lobe.

View larger version (74K): [in a new window]   Figure 4. Longitudinal section through the left parotid gland demonstrates a lobulated mass in the superficial lobe of the gland distorting the capsule. There is associated distal acoustic enhancement. Note marked heterogeneity of internal architecture. Biopsy confirmed this lesion to represent a pleomorphic adenoma. The mandible is indicated by arrowheads.

View larger version (112K): [in a new window]   Figure 5. Longitudinal section through the right parotid gland demonstrates a Warthin's tumour overlying the retro-mandibular vein. This is lobulated with internal cystic elements and hyperechoic septation is demonstrated (arrow).

View larger version (103K): [in a new window]   Figure 6. Longitudinal section through the left parotid gland demonstrates multifocal Warthin's tumour with a smaller nodule (curved arrow) adjacent to a larger lesion.

View larger version (70K): [in a new window]   Figure 7. Longitudinal section through the left parotid gland demonstrates a well circumscribed, hypoechoic solid mass in the superficial lobe near the angle of the mandible. Biopsy was performed (the needle is arrowed) and confirmed this lesion to represent an oncocytoma.

View larger version (97K): [in a new window]   Figure 8. Transverse section through the right parotid gland demonstrates a lipoma at its lower pole (callipers). This is well circumscribed with a striped internal echotexture. Note normal parotid tissue (arrow) and the lesion abuts the mandible.

View larger version (123K): [in a new window]   Figure 9. Longitudinal section through the left parotid gland demonstrates a retention cyst—anechoic and thin walled with distal acoustic enhancement. Note normal intraparotid vessels delineating superficial from deep lobes (retro-mandibular vein–arrow, external carotid artery–curved open arrow).

View larger version (80K): [in a new window]   Figure 10. Longitudinal ultrasound of the left parotid gland demonstrates an irregular, poorly defined mass in the superficial lobe with heterogeneous internal architecture. Biopsy confirmed this to represent mucoepidermoid carcinoma. Note extension of tumour superficially through the parotid capsule (arrow).

View larger version (77K): [in a new window]   Figure 11. Longitudinal ultrasound through the right parotid gland demonstrates a large, biopsy-confirmed, adenoid cystic carcinoma. The margins are poorly defined and there is tumour extension into the deep lobe (arrow) and through the superficial aspect of the gland (curved open arrow) beneath the skin.

View larger version (91K): [in a new window]   Figure 12. Longitudinal section through the right parotid gland demonstrates an irregular, poorly defined mass in the superficial lobe. Biopsy confirmed metastatic squamous cell carcinoma from a primary on the ipsilateral pinna.

View larger version (114K): [in a new window]   Figure 13. Longitudinal section through the right parotid gland demonstrates multiple enlarged, "pseudocystic" nodes in a patient with B-cell lymphoma. Biopsy confirmed lymphomatous nodal involvement.

View larger version (75K): [in a new window]   Figure 14. Longitudinal section through the right parotid gland in a patient with acute, painful parotid swelling. The gland is enlarged, hypoechoic and of a heterogeneous echotexture. The appearances are consistent with acute parotitis. Note an enlarged intraparotid reactive lymph node (curved open arrow).

View larger version (100K): [in a new window]   Figure 15. Longitudinal section through the left parotid gland in a patient with acute parotitis secondary to Escherichia coli. The gland is enlarged and hypoechoic. Multiple hyperechoic foci are present within the gland (long arrow) which represent air within intraglandular ducts secondary to sepsis. Note associated comet-tail artefacts. The normal facial nerve can be identified as a fibrillar structure (curved open arrow) lying lateral to the retro-mandibular vein.

View larger version (87K): [in a new window]   Figure 16. Longitudinal section through the right parotid gland in a middle-aged male who presented with acute onset of painful parotid swelling. The gland appears hypoechoic and inflamed and there is a poorly defined hypoechoic mass in the superficial lobe. The appearances are suggestive of parotid abscess formation and this was confirmed following ultrasound-guided aspiration of 5 ml of pus from the lesion from which viridans streptococcus was isolated.

View larger version (123K): [in a new window]   Figure 17. Ultrasound of the tail of the left parotid gland in an elderly male with a history of intermittent parotid swelling. This demonstrates a small intraglandular calculus (arrow) with associated distal acoustic shadowing.

View larger version (97K): [in a new window]   Figure 18. Longitudinal section through the tail of the right parotid gland in a patient who presented with painless enlargement of a nodule. Ultrasound demonstrates an enlarged hypoechoic node (callipers) which is heterogeneous and the fatty hilum is displaced peripherally. Biopsy was performed and confirmed involvement with M. tuberculosis with caseating granulomata demonstrated.

View larger version (124K): [in a new window]   Figure 19. Longitudinal section through the right parotid gland in a patient who presented with painless bilateral parotid and submandibular gland enlargement. The parotid gland is enlarged and hypoechoic and the texture is heterogeneous. Biopsy confirmed infiltration with sarcoid granulomata.

View larger version (134K): [in a new window]   Figure 20. Longitudinal section through the right parotid gland in a patient with Sjögren's syndrome. The gland is enlarged and heterogeneous and small internal hypoechoic foci are identified (arrow) which represent areas of sialectasis. Note a larger septated cyst (curved open arrow).