66-year-old Male with Chronic Parotid Swelling with Recent Onset Bleeding: A Case Report with Imaging

IntroductIonChronic parotid swelling, although a common presentation in otolaryngology, presents significant diagnostic challenges due to the variety of etiologies associated with this presentation, whether malignant, inflammatory, obstructive, or due to autoimmune conditions.In addition, the complex anatomy in the parotid region and the underlying risk of facial nerve damage due to surgical intervention require an approach that factors in a patient's symptoms, nature of swelling (benign or malignant), patient willingness to undergo surgery, and underlying pathology.Chronic parotid swelling often has an inflammatory pathology progressing to eventual ductal dilation and fibrosis, as seen in conditions such as chronic sialadenitis, leading to ductal erosion and more acute symptoms such as bleeding.1 In addition, conditions that cause obstruction, such as ductal strictures and sialolithiasis, have previously been documented causes of chronic parotid swelling, although the previous imaging did not demonstrate any evidence of this in the case of our patient 1,2 (Figs 1 and 2).Patients with autoimmune conditions such as sarcoidosis have been found to have a prevalence of parotid swellings of up to 2% in studies, often with bilateral swelling, although patients with recent onset of bleeding present a more uncommon scenario; thus, there is limited literature available on the onset of this symptom.3 It is important for any patient with longstanding parotid swelling to exclude any benign and malignant processes in the presence of new-onset symptoms.Imaging can help identify neoplastic and obstructive pathologies, as well as any structural abnormalities, thus guiding both diagnosis and further management of patients with chronic parotid enlargement.In addition, sialendoscopy can help for both diagnostic and therapeutic purposes for patients presenting with inflammation or obstructive pathologies, although the patient in this case study reported no improvement with previous widening of the ampulla.4