Images in Clinical Medicine

A Tuba Player with Air in the Parotid Gland

Deepa Mukundan, M.D., and Oliver Jenkins, M.D.

N Engl J Med 2009; 360:710February 12, 2009

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Article

A 13-year-old boy who had recently begun playing the tuba presented with a 2-day history of facial swelling on the left side and pain without fever or ear or nasal discharge. On physical examination, he had swelling of the left cheek with tenderness on palpation. There was no erythema or crepitance. Massage of the parotid gland resulted in expression of foamy secretions from the parotid duct. Computed tomography of the head, neck, and sinuses (Panel A) revealed air in the left parotid gland (arrow) and in the parotid duct. A reconstructed image (Panel B) also revealed air in the parotid gland (arrow) and lateral to the carotid sheath. There was no radiographic evidence of parotitis or involvement of the retropharyngeal space. The serum amylase level was three times the upper limit of the normal range, probably because of parotid injury; all other laboratory measures were normal. The boy received the diagnosis of pneumoparotid associated with playing the tuba; there was no evidence of parotid infection. Conservative management led to resolution of the symptoms within days. Pneumoparotid can arise in wind-instrument players, glassblowers, and persons in whom air under positive pressure in the oral cavity is forced into the parotid ductal system.

Deepa Mukundan, M.D.
University of Toledo, Toledo, OH 43608
deepa.mukundan@utoledo.edu

Oliver Jenkins, M.D.
Northwest Ohio ENT Consultants, Perrysburg, OH 43551

This article (10.1056/NEJMicm0706236) was updated on January 5, 2011, at NEJM.org.