Female, 81 years old, with a left parotid mass. An ill-defined lesion is evident within the left parotid gland occupying primarily the deep lobe and a small portion of the superficial lobe. The lesion measures at least 21 x 14 mm (image 30 series 701), and does seem to extend slightly through the stylomandibular canal.On T1-weighted images, the lesion is relatively isointense to skeletal muscle. On T2-weighted images, the lesion is very heterogeneous with portions which are hyperintense and other portions which are very hypointense potentially suggesting blood product. The lesion enhances in an ill-defined infiltrative manner with relative hypoenhancement centrally.Please note that microscopy coil images were attempted, but these were technically suboptimal. Spectroscopy of the lesion was also attempted as requested. The resulting spectrum (not shown) was dominated by a lipid peak which probably represents unavoidable inclusion of normal fatty tissue within the voxel. As such, the spectrum provided no additional diagnostic information. Likewise, relative cerebral blood volume mapping is noncontributory.There appear to be small cystic lesions elsewhere within the left parotid gland and within the right parotid gland of uncertain significance. The submandibular glands are unremarkable. The thyroid is only partially visualized.A mildly prominent left jugulodigastric lymph node is seen measuring 13 x 6 mm (image 19 series 701). No pathologic adenopathy is detected in the visualized neck by size criteria.The airway is patent and unremarkable. The osseous structures show normal signal intensity. On limited visualization of the intracranial compartment only minimal nonspecific periventricular T2 hyperintensity is seen.
An infiltrative masslike lesion is identified within the left parotid gland occupying primarily the deep lobe with mild involvement of the superficial lobe. The lesion extends slightly through the stylomandibular canal.The signal characteristics of the lesion are quite heterogeneous, particularly on the T2-weighted images, where there are components which appear to contain blood product. This could reflect intrinsic lesional hemorrhage or the effect of prior biopsy.No definite pathologic adenopathy is seen in the neck, though there is a slightly prominent left jugulodigastric lymph node.The differential diagnosis for this parotid lesion would include a primary parotid tumor. Imaging is not capable of distinguishing between benign and malignant etiologies, but the ill-defined and infiltrative appearance of this lesion is worrisome.