Pneumoparotitis

Abstract

The objective is to review a case of pneumoparotitis and to discuss how knowledge of this unique presentation is important when making differential diagnoses in emergency medicine. A patient with recurrent subcutaneous emphysema of the head and neck is reviewed. Stenson’s duct demonstrated purulent discharge. Physical examination revealed palpable crepitance of the head and neck. Fiberoptic laryngoscopy and barium esophagram were normal. Computed tomography demonstrated left pneumoparotitis and subcutaneous emphysema from the scalp to the clavicles. This is an unusual presentation of pneumoparotitis and malingering. Emergency physicians should be aware of pneumoparotitis and its presentation when creating a differential diagnosis for pneumomediastinum, which includes more life-threatening diagnoses such as airway or esophageal injuries.

Complicated spontaneous pneumoparotid mimicking a neck mass in a child with Down’s syndrome

“…Current consensus is that the term ‘pneumoparotid’ should be used in the absence of inflammatory changes of the gland and ‘pneumoparotitis’ should be used in the presence thereof. 2 …”

“…In addition, oral bacteria may also reflux, predisposing to recurrent episodes of parotitis, termed ‘pneumoparotitis’, which can lead to ductal ectasia if chronic, or associated abscess formation. 2 , 3 , 4 …”

“…Self-induced pneumoparotid has also been reported in conjunction with psychiatric and psychosomatic disorders or because of an unintentional adjustment reaction to achieve secondary gains (such as avoiding school), especially in adolescents. 2 , 3 , 4 …”

“…Plain film and fluoroscopic studies will likely be normal or demonstrate only complications such as surgical emphysema or pneumothorax and may not be sufficient to delineate the underlying cause. 2 Ultrasound, as a first line of radiological investigation in the paediatric population, is a valid consideration because it will demonstrate air bubbles as intraductal, mobile, comet-tail artefacts. High-frequency ultrasound may be useful in delineating potential associated ductal alterations and calculi.…”

“…Several surgical treatment options have been suggested for chronic and recurrent pneumoparotid, such as transposition of Stensen’s duct to the tonsillar fossa, ligation of the duct or superficial parotidectomy if chronic or recurrent infection occurs. 2 , 3 …”