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with 50% being present at birth. Most regress before the age of 5 years, and surgery is indicated only if there is aggressive growth. Acute swelling related to haematoma is extremely rare and is usually a complication of parotidectomy or fine-needle aspiration (FNA);
A 9-year-old boy presented to the Royal London hospital with a 1 week history of a tender subcutaneous swelling over the right side of his face with no predisposing factors or other clinical signs. Ultrasound was not helpful, but an MRI scan showed intermediate signal consistent with necrotic tissue within the superficial parotid extending to the deep lobe (Fig. 1) . In view of the inconclusive diagnosis, a superficial parotidectomy incision was used to explore the swelling, and a collection of unclotted blood enclosed by an ill-defined pseudocapsule was noted. Tissue was sent for histology, which showed dilated vascular channels consistent with haemangioma.
Figure 1Axial MRI at the level of the parotid gland and alveolar process. On T1 weighting there is a well-defined large area of intermediate signal lying behind the ramus of the left mandible and inseparable from the medial and deep aspects of the left parotid gland. Signal characterised on T1 weighting is not typical of a haematoma.
MRI is the investigation of choice for parotid haemangioma, and characteristically shows a dark lesion on T1-and a bright lesion on T2-weighted images.
However, it was not useful in this case, probably because of the unclotted blood, which had the same density as circulating blood and necrotic tissue.
Spontaneous swelling of the parotid as a result of haemangioma in a child with no predisposing factors has not been previously reported. This may be because of the involution of such swellings, and they should be considered as a differential diagnosis.
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