Differentials
Mumps
SIGNS / SYMPTOMS
Unilateral or bilateral self-limiting swelling of the parotid gland. Orchitis or oophoritis may develop.
INVESTIGATIONS
Usually a clinical diagnosis.
IgM is positive for up to 4 weeks after infection, but testing should not be done in the first 3 days. May be falsely negative if previously immunised.
Sarcoidosis
SIGNS / SYMPTOMS
Usually bilateral (although unilateral parotid swelling has been reported), persistent, and only rarely mildly painful. Called Heerfordt's syndrome when accompanied by fever, uveitis, and facial palsy.
INVESTIGATIONS
Biopsy will show presence of non-caseating granulomas.
Serum calcium level and 24-hour urinary calcium levels are often elevated.
Chest x-ray: bilateral hilar lymphadenopathy with or without pulmonary infiltrates.
Serum ACE levels are often elevated.
Tuberculosis
SIGNS / SYMPTOMS
Tuberculous parotitis is rarely encountered. Typically painless unilateral swelling of the parotid region. May demonstrate chronic productive cough, fatigue, weight loss, and fever.
INVESTIGATIONS
Chest x-ray: Infiltrates, cavities, or consolidation often in the upper lobes with lymphadenopathy.
Sputum acid-fast bacilli (AFB) smear and sputum culture: positive.
Fine needle aspiration and/or biopsy: AFB smear or culture positive.
HIV test: positive or negative.
Parotid and submandibular tumours
SIGNS / SYMPTOMS
Asymptomatic or symptomatic swelling of a salivary gland. Rapid growth, pain, ulceration, and facial palsy are suggestive of the presence of a malignancy. An indolent asymptomatic and growing mass is suggestive of the presence of a benign neoplasm, although lymphomas may display indolent behaviour.
INVESTIGATIONS
CT scan will show a solid mass clearly distinct from the surrounding tissues. Abscess formation is uniformly absent. In the absence of any evidence suggesting the presence of inflammation, fine needle aspiration cytology is warranted. The presence of sialolithiasis argues against a tumour diagnosis.
MRI offers excellent resolution of soft tissue structures including tumour and its relationship to surrounding structures.
Dental abscess
SIGNS / SYMPTOMS
History of toothache or recent dental surgery, bleeding gums, poor dental hygiene, and pain elicited when affected tooth is pressed into the gum.
INVESTIGATIONS
Usually a clinical diagnosis.
Dental x-rays may demonstrate presence of abscess.
Ludwig's angina
SIGNS / SYMPTOMS
History of recent dental infection or impacted lower third molar (wisdom tooth).
Presents as a rapidly progressive cellulitis of the soft tissues of the neck and floor of the mouth. May be accompanied by fever and significant stridor.
INVESTIGATIONS
Usually a clinical diagnosis.
Dental x-rays may demonstrate presence of abscess or impacted third molar.
Angio-oedema
SIGNS / SYMPTOMS
Rapid onset of facial swelling may be accompanied by respiratory impairment with stridor or abdominal pain. May occur in a hereditary form or as a response to allergy.
INVESTIGATIONS
Decreased levels of C2 and C4 serum complement levels.
Use of this content is subject to our disclaimer