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British Journal of Radiology (2004) 77, 600-606
© 2004 British Institute of Radiology
doi: 10.1259/bjr/15671187
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Vascular lesions of parotid gland in adult patients: diagnosis with high-resolution ultrasound and MRI

K T Wong, FRCR, A T Ahuja, FRCR, A D King, FRCR, E H Y Yuen, FRCR and S C H Yu, FRCR

Department of Diagnostic Radiology and Organ Imaging, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR




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  		Figure 1. 75-year-old man with pseudoaneurysm in the left parotid gland. (a) Transverse grey-scale ultrasound of the left parotid gland shows a well-circumscribed hypoechoic heterogeneous mass with internal "cystic" spaces (arrows) and calcification (arrowheads). (b) Transverse power Doppler ultrasound of the left parotid gland reveals the presence of colour flow within "cystic" spaces and a supplying artery (arrow) deep to the left parotid mass. (c) Axial spin-echo T1 weighted MRI (450 ms/13 ms/2 [repetition time/echo time/number of signal averaging]) shows a well-circumscribed mass (arrows) with signal intensity similar to muscle centred in the deep lobe. (d) Coronal post-gadolinium fat-suppressed spin-echo T1 weighted MRI (520/13/2) shows avid homogeneous enhancement of the lesion. (e) Digital subtraction angiogram of left external carotid artery (lateral projection) confirms a pseudoaneurysm (arrow) with slightly lobulated outline arising from the distal portion of posterior auricular artery (arrowhead). (f) Magnified digital subtraction external carotid arteriogram (lateral projection) shows successful embolisation of the posterior auricular artery by fibred microcoil. Note absence of contrast filling of the aneurysmal sac after the procedure.

 



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  		Figure 2. 57-year-old woman with arteriovenous fistula in the left parotid gland. (a) Transverse grey-scale ultrasound of left parotid gland shows a well-circumscribed cystic lesion with internal septation involving both superficial and deep lobes (arrow). (b) Transverse grey-scale ultrasound of the left parotid region shows dilated and tortuous vascular channels in the vicinity of the lesion (arrows). (c) Axial fat-suppressed spin-echo T1 weighted MRI (520/13/4) shows conglomerate serpiginous signal void involving superficial and deep lobe of left parotid gland. (d) Digital subtraction left external carotid angiogram in anteroposterior projection. (e) Digital subtraction left external carotid angiogram in lateral projection. Numerous tortuous dilated veins in the left parotid region are shown (d, e) supplied by a hypertrophied feeder from external carotid artery (arrow) and drain into left external jugular vein (arrowhead). (f) Post-embolisation digital subtraction left external carotid angiogram in lateral projection shows complete obliteration of the arteriovenous fistula.

 



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  		Figure 3. 35-year-old man with haemangioma in the right parotid gland. (a) Transverse grey-scale ultrasound of the right parotid gland shows a heterogeneous hypoechoic mass (white arrows) with sinusoidal spaces (arrowheads) and phlebolith (black arrow). (b) Axial spin-echo T1 weighted MRI (450/13/2) shows a mass involving superficial and deep lobes (arrows) which shows signal intensity similar to muscle. (c) Fat-suppressed fast spin-echo T2 weighted MRI (2500/120/2) shows markedly hyperintense signal intensity of the right parotid mass. Internal small round (arrows) and serpiginous (arrowhead) signal voids represent phleboliths and small vessels within the lesion, respectively. A similar smaller lesion is seen in right submandibular region (white arrow). (d) Fat-suppressed spin-echo T1 weighted MRI (520/13/2) shows enhancement of the intraparotid lesion after intravenous gadolinium administration.(e) 99mTechnetium pertechnetate labelled red blood cell scan in anterior acquisition shows red cell sequestration in right parotid region (arrow). Smaller areas of red cell sequestration are also demonstrated in right submandibular region (arrowhead) and left tongue base (open arrow).

 




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