Parotid Hemangioendothelioma in a Child: an Uncommon Imaging Diagnosis

Abstract

Noninflammatory masses of the salivary gland region in children are extremely rare. Nevertheless, hemangioendothelioma of the parotid gland is the most common tumor of the salivary glands in childhood, accounting for about 50% of all cases.

Physical examination is usually diagnostic in typical cases and imaging modalities can strengthen the suspected diagnosis in difficult cases.

 We present the case of a 1 month and 18-day-old child with right submandibular swelling of sudden onset and painless. There was no alteration of the overlying skin. Ultrasound demonstrated an enlarged and heterogeneous gland with increased vascularization that could represent either an infectious process or a vascular malformation. Magnetic Resonance Imaging performed later demonstrated a lobulated mass replacing almost the entire right parotid gland and confirmed the diagnosis of hemangioendothelioma. The child then started treatment with propanolol and the swelling reduced considerably.

This case illustrates an atypical presentation of a parotid hemangioendothelioma with no involvement of the skin overlying the lesion, thus making diagnosis challenging. Therefore, it is essential to know the imaging features associated with hemangioendothelioma of the parotid gland in order to be able to identify this lesion on radiological studies and avoid an unnecessary biopsy.