Parotid CT Results

[dodger04]

Just got the results of my CT but ENT is out of town till next week. So I am left to wonder and worry. CT was ordered for a bulge under my left ear that has been there for nearly two years. Two previous ENT's more or less said it was nothing, but this time I demanded a CT.
Here are the results. Please let me know if you have any input.

Findings:
There appears to ba a subtle 1.8cm nodule involving the posterior margin of the left parotid gland superficial lobe abutting the skin surface inferior to the pinna.

No neck adenopathy is present

Conclusion:
Probable subtle left parotid mass. Further evaluation with gadolinium enhanced MR neck recommended.

[OHNS2010]

Hi,

No more worries! The parotids are normal, with out any other benign or malignant growths. The reactive lymph nodes suggests of a recent infection inside the throat or ongoing infection inside throat or oral cavity. If you feel the nodes are very troublesome, you can visit your doctor and ask for medicines.

All the Best
Regards OHNS2010

[Londres70]

Well, sounds like it is NOTHING maligant/cancer; good news; the nodes are presumed reactive.  All nodes are seen, but no mass at all.  Nothing really significant in the findings except for the curve in your cervical spine; Scoliosis was noted in your cervical spine positioning to the left.  

[dodger04]

Results of gad. enhanced MRI are as follows. Leaves me a little confused.

No parotid mass is seen. Specifically, no left side perotid lesion is identified. Bilateral jugulodigastric lymph nodes are present, with 2 adjacent lymph nodes on the left with the largest measuring 13x6 mm, and with a 13x9 mm right-sided jugulodigastric lymph node. These are presumably reactive. Minimal prominance of oropharyngeal tonsillar tissue is present, appearing symmetric, most, most probably normal.

No aerodigestive tract abnormality is seen. There is slight midcervical scoliotic positioning to the left.

CONCLUSION: No parotid mass seen.

So, what do you think?

[OHNS2010]

Hi,

FNAC would be better choice. Its overall accuracy is greater than 96%, with a sensitivity for benign tumors of 88-98% and a specificity of 94%. You get a provisional diagnosis and it can be further managed accordingly.

Regards

[Londres70]

I would recommend getting this MRI with the gadolinium; it will enhance the image.  CT  imaging is good, but in this case the MRI would be best for you.  Secondly, it should be biopsied as I had stated in a previous post.  

[ENTMD]

OK, well they are calling this a parotid mass (as opposed to a subcutaneous mass, independent of the parotid gland).  

These are typically either excised or evaluated with a fine needle aspiration (FNA, a biopsy).  FNA is not entirely reliable in the salivary glands, so there is controversy as to whether this is even necessary.

Most likely, this is a benign mass, but only removal of the mass will prove that to be the case for certain.  You may have a choice to make here -- assume its benign (or get an FNA that may support that) and continue to monitor it, or have it removed.  Removal comes with its own set of risks and benefits, I'm sure your ENT surgeon will explain these.  MRI is an option too, but I generally don't bother with this.