Imaging of parotid anomalies in infants and children

US and CT of 2 pediatric cases of self-inflicted pneumoparotid and cervicofacial emphysema

Pneumoparotid is a rare cause of parotid swelling characterized by the presence of air in the Stensen's duct and/or the parotid gland. In children, it is often self-inflicted, due to psychiatric disorder or recreational habits (puffing the cheeks, blowing balloons, bruxism…). The diagnosis may be suggested by specific signs such as crepitus or foamy saliva flowing from the Stensen's duct. Here, we present 2 cases of involuntary self-inflicted pneumoparotid, diagnosed by ultrasound and CT, in a child and a teenager. Imaging is useful for diagnosis and excluding complications. Ultrasonography may be sufficient to make the diagnosis of pneumoparotid but is less sensitive than CT. CT can make the diagnosis, but also more completely explores the deep cervical spaces and the thorax, especially important in cases with respiratory symptoms. Treatment is usually conservative, in association with behavioral counselling or psychologic/psychiatric therapy, to avoid activities leading to intra oral pressure increase.

Congenital and Infantile Masses of the Head and Neck

The spectrum of congenital and infantile masses of the head and neck is broad, including developmental and neoplastic entities. The diseases encountered in this vulnerable patient population differ substantially from those in older children and adults. Familiarity with the types of encountered masses, typical imaging characteristics, and expected clinical course is critical for radiologists who care for pregnant women (fetuses) and infants. This knowledge allows radiologists to provide a timely diagnosis and appropriate follow-up imaging recommendations and, in some fetal imaging cases, inform delivery planning. This article uses a location-based approach to highlight imaging features of numerous common and rare congenital and infantile masses of the head and neck. ©RSNA, 2024 Supplemental material is available for this article.

MRI in the prenatal genetic diagnosis and intrauterine treatment of fetal congenital cystic adenoma of the lung

OBJECTIVE

To investigate the value of magnetic resonance examination technique for prenatal genetic diagnosis and clinical intrauterine treatment of fetal congenital cystic adenoma (CCAM) of the lung.

METHODS

A retrospective analysis was conducted on 108 pregnant women admitted to a certain hospital from January 2016 to January 2022 for pre natal examination and consultation on eugenics. The selected pregnant women were aged 20-40 and had a gestational age of 17-36 weeks. Ultrasound and MRI examinations were performed on 108 pregnant women who met the inclusion criteria. Follow-up and investigation were conducted on the fetus after being diagnosed with CCAM. To analyze the results of prenatal genetic diagnosis, chromosome microarray analysis (CMA) was used to analyze samples with pathogenic Copy Number Variants (CNV) and identify pathogenic genes. Finally, the imaging diagnosis results obtained through statistical software were analyzed, and the correlation between pathogenic genes and CCAM, as well as the clinical application value of MRI in fetal intrauterine treatment was explored.

RESULTS

Among all cases, 68 fetuses were diagnosed with CCAM through ultrasound examination; 71 fetuses were diagnosed with CCAM through MRI examination. A total of 74 samples were confirmed as CCAM by autopsy and neonatal CT. The sensitivity, specificity, and accuracy of MRI in diagnosing fetal congenital CCAM were higher than those of ultrasound examination. The expression of CCAM was positively correlated with DUSP22, PRSS1, and SHOX, with all R values greater than 0.8. The clinical decision curve showed that when the probability of fetal CCAM was less than 0.03, the prenatal genetic diagnostic model of MRI was not applicable; But when the probability of fetal CCAM was higher than 0.05, the auxiliary intrauterine treatment effect that MRI diagnostic methods achieved was significantly better than conventional diagnosis.

CONCLUSION

MRI is significantly better than ultrasound in the diagnosis of CCAM, which can effectively improve the sensitivity of diagnosis and provide accurate information for the eugenics of pregnant women, and has high clinical application value.

Juvenile Xanthogranuloma of the Head and Neck: Imaging Findings in 11 Cases

BACKGROUND

Juvenile Xanthogranuloma (JXG) is a non-Langerhans cell histiocytosis, occurring mainly in infancy. With an extracutaneous lesion, its diagnosis is difficult, because of a wide clinical spectrum. Here we demonstrate and characterize imaging features of 11 patients with JXG of the head and neck in various locations.

MATERIAL AND METHODS

We recorded clinical data and reviewed all imaging studies of 11 patients with JXG of the head and neck. Ultrasonography (US) alone was performed in 1 patient; MRI alone in 6 patients; US and MRI in 1 patient; and US, CT, and MRI in 3 patients. We evaluated the following characteristics in all studies: location and number of lesions, echogenicity and vascularization on US, density on CT, signal intensity on T 1 - and T 2 -weighted images, ADC and enhancement on MRI, and tumor boundaries and bone involvement.

RESULTS

Lesions were well-defined in 9 cases, and bone erosion was present in 2. On US, lesions were hypoechoic or hyperechoic and with or without vascularization. On CT, lesions were hyper-dense, with no calcification. On MRI, lesions were mildly hyper-intense or iso-intense on T 1 -weighted images in 8 of 9 patients, hypo-intense on T2-weighted images in 7 of 10, low ADC in 7 of 9, and enhancement in 7 of 7.

CONCLUSIONS

The diagnosis of extra cutaneous JXG may be proposed, with the following suggestive criteria: age < 1 year, well-defined lesion, mild hyper-intensity on T 1 -weighted images, hypo-intensity on T 2 -weighted images, low ADC, enhancement, and possible adjacent bone involvement.

Evaluation of the anterior processes of the parotid gland: an ultrasonographic study

OBJECTIVES

This study aimed to determine the prevalence of anterior extensions of the parotid gland (AEPG), namely the accessory parotid gland (APG) and the facial process of the parotid gland (FP), using ultrasonography.

STUDY DESIGN

A total of 338 parotid glands were scanned bilaterally. APG was defined as a soft tissue mass with the same echogenic features as the main parotid gland (MPG) and not in contact with it, while FP was defined as an extension that exceeded the anterior border of the mandibular ramus and was continuous with the MPG. The anteroposterior, mediolateral, superoinferior dimensions and the mean distance from the MPG to the APG were measured.

RESULTS

The prevalence of APG and FP were 19.5% and 36%, respectively, resulting in an AEPG prevalence of 55.6%. The presence of APG was statistically higher in females than in males (p = 0.039). The mean anteroposterior, mediolateral, and superoinferior dimensions of the APG were 18.1 ± 0.57 mm, 0.35 ± 0.17 mm, and 12.3 ± 0.36 mm, respectively, and the mean distance from the MPG was measured as 12.1 ± 0.87 mm.

CONCLUSION

This study can raise awareness among clinicians about the presence of AEPG in the differential diagnosis of mid-cheek masses.

Idiopathic Parotid Gland Abscess in a Pediatric Patient

Parotid abscesses are sequelae of acute parotitis that are rare in pediatric patients. Common inciting causes of parotid abscesses include infection, inflammatory conditions, and ductal obstruction. This case presents a parotid abscess found in an otherwise healthy four-year-old girl. Further evaluation revealed no evidence of infection, no anatomical ductal obstruction, and no evidence of autoimmune conditions that could have caused the abscess. Nonetheless, the patient was treated with an incision and drainage procedure and antibiotic therapy with full recovery. Development of a parotid abscess with no identifiable cause is exceedingly rare with limited documented instances. From this case, idiopathic parotid abscesses may be considered as a diagnosis of exclusion after ruling out common causes, though management still follows the standard of care.

Congenital Bilateral Ectopic Parotid Glands: Case Report with Literature Review

Congenital ectopic bilateral parotid glands are extremely rare, to date only two cases have been reported in the literature. Our patient, a 5-day-old male, presented with bilateral palpable cheek swelling. On imaging, the absence of bilateral parotid glands in parotid space and their ectopic location, anterior to the masseter muscle, was seen. Our case emphasizes ectopic parotids as an important differential among conditions presenting with bilateral cheek swelling in children. We have also compared the findings of previously described cases and their management with our case.