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These lesions are comprised of mixed cystic and solid masses within the parotid (much less in the SMG and SLG). CT shows multiple cystic and solid masses with associated parotid enlargement. IV contrast shows mild peripheral enhancement in the cysts and more heterogenous enhancement in the solid lesions (Figure 2.55). MRI images of the cysts are typical with low signal on T1 and high on T2. The more solid lesions are of heterogenous soft‐tissue signal on T1 and increase on T2. Contrast MRI images follow the same pattern as CT (Holliday 1998). The US images show heterogenous cystic lesions with internal architecture of septation and vascularity and slightly hypoechoic signal of the solid masses. Mural nodules may be seen in predominantly cystic lesion. Associated cervical lymphadenopathy is commonly seen as well as hypertrophy of tonsillar tissues. Differential diagnosis of these findings includes Sjögren syndrome, lymphoma, sarcoidosis, other granulomatous diseases, metastases, and Warthin tumor (Kirshenbaum et al. 1991; Som et al. 1995; Martinoli et al. 1995; Shah 2002; Madani and Beale 2006a).

Figure 2.55. Axial CT demonstrating a large cystic lesion in the right parotid gland and multiple small lesions in the left parotid diagnosed as lymphoepithelial cysts.