Cases reported "Parotid Diseases"

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1/7. Wegener's granulomatosis with parotid gland involvement and pneumothorax.

    OBJECTIVE: Wegener's granulomatosis is a systemic vasculitis characterized by necrotizing granulomatous lesions mostly involving the upper and lower respiratory tract. The disease rarely causes parotid gland involvement and pneumothorax. We report a case of Wegener's granulomatosis involving parotid gland, and complicated with a pneumothorax. CLINICAL PRESENTATION: A 45-year-old man admitted with a 3-week history of painful left parotid gland enlargement and hemoptysis. On physical examination a painful and hard mass was detected on the left pre-auricular area. Cervical CT revealed a 2 x 1.5 cm hypodense lesion mimicking an abscess on the left parotid gland. Chest radiograph and thorax CT demonstrated nodular and cavitating opacities on the right and left upper zones. There were numerous erythrocytes in urine sediment. The drained pus material from the parotid abscess demonstrated only gram-positive cocci (staphylococcus aureus). Two weeks treatment with teicoplanin resulted in no improvement. Meanwhile, parotid gland biopsy revealed necrotizing granulomatous inflammation. There was a sixfold increase in serum cANCA levels. With the diagnosis of Wegener's granulomatosis, cyclophosphamide and prednisolone were initiated. However, 1 month later, pneumothorax developed as a complication of rupture of a cavitary lesion. CONCLUSION: parotid gland swelling may be the initial presenting symptom of Wegener's granulomatosis. It can be confused with infectious or malignant diseases of the gland, and the lung involvement may be complicated with pneumothorax.
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ranking = 1
keywords = necrotizing
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2/7. Wegener's granulomatosis presenting as unilateral parotid enlargement.

    OBJECTIVE: Major salivary gland enlargement is a rare presenting symptom of Wegener's granulomatosis. The unrecognized occurrence of this entity can delay diagnosis, leading to increased morbidity from disease progression. This report discusses the clinical features and diagnostic testing of salivary gland enlargement secondary to Wegener's granulomatosis to differentiate it from other, more common, salivary gland diseases. STUDY DESIGN: A case report of a single subject with unilateral parotid gland enlargement secondary to Wegener's granulomatosis. methods: A review of the clinical course, diagnostic studies, and histopathology related to the presenting disease. RESULTS: A 54-year-old male was evaluated for a 6-week history of progressive right parotid enlargement and pain unresponsive to antimicrobial therapy. Computed tomography scans showed diffuse, unilateral parotid swelling without enhancement and without a mass lesion or sialolith. Multiple open biopsies from the gland were necessary to demonstrate the presence of necrotizing granulomatous inflammation with vasculitis. Elevated antineutrophil cytoplasmic autoantibody, cytoplasmic pattern (c-ANCA) titers confirmed Wegener's granulomatosis. hemoptysis and acute renal failure requiring hemodialysis developed shortly after diagnosis but eventually resolved after the initiation of corticosteroids and cyclophosphamide. CONCLUSIONS: Unilateral parotid enlargement is a rare presentation of Wegener's granulomatosis. A high level of clinical suspicion should prompt biopsy and testing of c-ANCA when initial studies or empirical treatment fails to lead to a proper diagnosis. Early treatment may prevent the development of other serious systemic complications such as renal failure.
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ranking = 0.5
keywords = necrotizing
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3/7. Sialosis and necrotising sialometaplasia in bulimia; a case report.

    Salivary gland involvement, particularly salivary gland enlargement (sialosis), is a recognised complication in bulimia. We report the rare association of sialosis and necrotising sialometaplasia with bulimia in the same patient. The association of sialosis and necrotising sialometaplasia in the same patient with bulimia has been reported previously in two patients and may be coincidental, but the appearance in this additional patient suggests it may be prudent to explore this further.
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ranking = 9977.6749925287
keywords = sialometaplasia
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4/7. Sialometaplasia arising in the ectopic salivary gland ductal inclusions of multiple intraparotid lymph nodes.

    Sialometaplasia, squamous metaplasia of salivary gland lobules, is a benign condition occasionally presenting with lesions clinically simulating malignancy. "Necrotising sialometaplasia", recognised by lobular infarction, necrosis, and simultaneous squamous metaplasia of ducts and acini is a well known condition. There are only a few reports of the "proliferative type of sialometaplasia", which is recognised by a more mature morphology of larger and more irregular metaplastic nests, lacking necrosis. This report describes a unique case of "proliferative sialometaplasia of multiple intraparotid lymph nodes" occurring in a 55 year old woman, presenting with multiple parotid lumps. This interesting case points to the importance of intraparotid lymph nodes as sites for multiple lesions of the parotid region.
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ranking = 4988.8374962644
keywords = sialometaplasia
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5/7. Wegener's granulomatosis mimicking a parotid abscess.

    We present the case of a previously healthy 59-year-old man who was under treatment for scleritis and episcleritis when he developed a parotid-gland swelling and pus-producing sinus. On surgical exploration, the features were those of a parotid abscess, but the lesion not only failed to heal post-operatively but increased in size very significantly. There was also severe necrotizing keratitis of the eyes. Due to clinical suspicion and a positive antineutrophil cytoplasmic antibodies test, Wegener's granulomatosis was diagnosed and the patient successfully treated with cyclophosphamide and steroids. Previously, a number of cases of Wegener's granulomatosis causing salivary-gland swelling have been reported in the literature; this is the first case in which the disease has masqueraded as a parotid abscess.
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ranking = 0.5
keywords = necrotizing
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6/7. Wegener's granuloma--presenting as a unilateral parotid swelling.

    Wegener's granuloma is a systemic necrotizing vasculitis which predominantly affects the upper and lower respiratory tracts and kidneys. The nose and paranasal sinuses are often the first or main sites to be affected. Equally ear involvement is common and a recognized early manifestation of the disease. Salivary gland involvement is rare and is usually part of more widespread systemic involvement. We present a 34-year-old female with a six-week history of hearing loss and a unilateral parotid swelling. One year previously she was diagnosed as having myalgic encephalomyelitis following a long period of post-viral malaise. The case points to the difficulties encountered when Wegener's granuloma presents in an unusual and varied way. A high index of suspicion coupled with early diagnosis and treatment is essential. The patient made a good recovery.
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ranking = 0.5
keywords = necrotizing
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7/7. Reconstruction of mandible and surrounding soft tissues in patient with necrotizing fasciitis.

    Necrotizing fasciitis is rare in the orofacial region, with fewer than 20 cases reported in the literature. Extension of the disease process to involve the underlying bone has not been previously reported. A patient is presented in whom destruction of superficial skin and fascia, necrosis of a portion of the mandible, and involvement of the parotid gland complicated reconstruction.
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ranking = 2
keywords = necrotizing
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