Question-227

A patient presents with preauricular swelling. Sometimes it hurts when he eats. Also he developed dry eyes and polyarthritis 2 years ago. USG done – no specific findings, just swelling, FNAC – inflammatory cells, nothing specific. What is the next investigation?


a. Sialography
b. MRI face
c. CT head
d. Biopsy of the swelling

Parotid swellings occur in that region.If there is Facial nerve involvement then it is probably malignant.
The next investigation would be MRI face.

Why not CT head ?

Dear Sue
Looking at question again,I wonder if the diagnosis could be Sjogren's Syndrome.
Thank you

Dry eyes (keratoconjunctivitis sicca)+  eatingxerostomia + polyartrities strongly support the patient may suffer Sjogren's Syndrome.The best lab tests approching Sjogren's Syndrome  may include:
Schirmer’s test – special blotting paper held to the eye is used to assess the degree of tear production
eye examination – including the use of special dyes
biopsy – a small tag of salivary gland tissue is removed (usually from the lip) and examined in a laboratory
blood tests – a series of blood tests may be performed to check the levels of particular immune system cells and immunoglobulins and for autoantibodies in the blood. The paraclinic producer lat tests done no support the diagnosis. The most important clue is recentlly patient's Facial nerve involvment which bring in  my mind some malignancy so MRI face (b) seemes to me is correct answer.