A Perplexing Pediatric Parotid Mass

A previously healthy 8-year-old boy presented to an outpatient clinic for further evaluation of a fluctuating right parotid mass that had been present for 3 years. The patient was not immunocompromised and denied any trauma to the area. In the 2 months prior, he had received multiple rounds of antibiotics from other health care professionals. Outside computed tomography of the face showed a 3-cm cystic structure in the superficial aspect of the right parotid gland with associated lymphadenopathy. An outside health care professional had attempted incision and drainage of the area with negative cultures. The patient presented to our clinic with an isolated right 2-cm fluctuant and tender mass overlying the parotid gland. There was no accompanying cervical lymphadenopathy, and facial nerve function remained fully intact. The patient denied fevers or systemic symptoms. Results of laboratory evaluation revealed normal complete blood cell count and erythrocyte sedimentation rate levels with negative infectious workup results for Epstein-Barr virus, cytomegalovirus, HIV, and tuberculosis (TB). Magnetic resonance imaging showed a 1.9-cm peripherally enhancing, centrally necrotic lesion overlying the superficial right parotid gland with multiple subcentimeter necrotic lymph nodes within the right parotid gland (Figure 1).