A boy aged 5 years presented with enlargement of soft tissues in the right side of the face associated with low-grade fever and ear pain. He subsequently developed edema in the gonial angle, in absence of discharge from Stensen’s duct or cardinal signs of inflammation. The history was unremarkable, and the patient was fully vaccinated.
The ultrasound scan (Figs. 1 and 2, Appendix B video) showed diffuse and heterogeneous enlargement of the right parotid gland, with multiple homogeneous and hypoechoic nodular foci. The appearance of the contralateral parotid gland was normal. The working diagnosis was acute viral parotitis, and a saliva specimen was collected to test for mumps virus, which turned out negative.
The sonographic features of viral parotitis include gland enlargement, decreased echogenicity, intraglandular hypoechoic foci, a homogeneous echotexture and increased vascularity on color Doppler, with intraglandular reactive lymphadenopathy. A pattern of scattered circular anechoic foci surrounded by a hyperechoic halo known as the “pomegranate sign” may be seen, which is indicative of sialectasis.1,2
This pattern is found in juvenile recurrent parotitis (JRP), the second leading form of parotitis. It manifests with recurrent episodes of parotitis of unknown etiology without purulent discharge or obstruction. It may be associated with immunodeficiencies and autoimmune diseases (Sjögren syndrome).3
In light of the sonographic findings, JRP was considered the most likely diagnosis, contingent upon future confirmation based on the clinical course observed during follow-up.
