Differential Diagnosis for Parotitis

The provided clinical presentation describes a patient with swelling in the right upper neck, centered just below the angle of the mandible, which is a common location for the parotid gland. Here's a differential diagnosis based on the given information:

• Single most likely diagnosis

  • Parotitis: The swelling's location just below the angle of the mandible, which is where the parotid gland is situated, along with the firm nature of the swelling and subtle erythema, makes parotitis a strong consideration. Parotitis refers to inflammation of the parotid gland and can be caused by viral or bacterial infections, among other causes.

• Other Likely diagnoses

  • Lymphadenitis: Inflammation of the lymph nodes in the neck could present similarly, especially if the nodes are located near the parotid gland. The absence of fluctuance and the firm nature of the swelling might lean more towards lymphadenitis rather than an abscess.
  • Submandibular gland infection or inflammation: Although the swelling is described as being centered just below the angle of the mandible, which is more typical for parotid gland pathology, the submandibular gland is nearby and could potentially cause similar symptoms if involved.
  • Benign or malignant tumor: A firm, non-fluctuant swelling could also suggest a tumor, either benign (like a pleomorphic adenoma) or malignant, though these would typically have a more gradual onset.

• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)

  • Parotid abscess: Although the description mentions no fluctuance, early abscesses might not have fluctuance. Missing a parotid abscess could lead to severe complications, including spread of infection.
  • Necrotizing fasciitis: This is a rare but life-threatening condition that could present with swelling and erythema. The absence of significant skin findings and the firm nature of the swelling make this less likely, but it should always be considered in cases of neck swelling and erythema.
  • Angioedema: While typically presenting with more diffuse swelling and often involving the face and lips, angioedema could potentially cause localized swelling in the neck area and is a medical emergency due to the risk of airway compromise.

• Rare diagnoses

  • Sjögren's syndrome: An autoimmune disorder that can cause parotid gland swelling among other symptoms, but this would typically be part of a broader clinical picture including dry eyes and mouth.
  • Sarcoidosis: A systemic disease that can cause swelling in various parts of the body, including the parotid gland, but would usually be accompanied by other systemic symptoms or findings.
  • Kimura disease: A rare, chronic inflammatory disorder that can cause lymphadenopathy and swelling in the head and neck region, often with eosinophilia.