A Cheeky Diagnosis

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HPI: 3 yo female with no PMH presenting for L sided facial pain and swelling x 1 day.

POCUS of affected side showed:

Note the hypoechoic spots within the gland that give it a “moth eaten” appearance. This is a classic finding in parotitis. Note the dilated ducts within which may represent a distal sialolithiasis.

Note nearby lymph nodes above.

Contralateral side for comparison:



Signs of parotitis on POCUS:

  • Enlarged, heterogeneous gland compared to contralateral side

  • Increased vascularity/color flow

  • Duct dilation

  • Increased quantity of surrounding lymph nodes

Case conclusion: The patient was diagnosed with likely viral parotitis. She was well appearing with no fever, overlying cellulitis, or trismus and was discharged with Pediatrician follow up!


Happy Scanning!

  • The US Team

Learn more:

  1. https://www.acep.org/sonoguide/advanced/ent

  2. https://ultrasoundpaedia.com/parotid-gland-normal/

VOTW: Mass-ive Fever

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This weeks’ VOTW was brought to you by Drs. Hannah Blakely, Patricia Camino, and the ultrasound team that was scanning that day!

HPI: 6 year old female with PMH of atrioventricular canal defect s/p repair, recent strep throat infection presenting for fever x 14 days.

Bedside POCUS showed:

Evaluating for endocarditis on POCUS:

B mode: look for masses, usually on the lower flow side of the valves (ex: mitral valve- endocarditis is more likely to be found on atrial side).

Color flow: you can usually find associated regurgitation of the affected valve

Possible mimics:

  • Thrombus

  • Papillary muscle rupture/flail leaflet

  • Intracardiac tumor

  • Artifact

Remember that a valve vegetation is one of the major diagnostic criteria for endocarditis. In the right clinical scenario this POCUS finding can highly increase your suspicion for endocarditis.

Case conclusion: CTAP significant for possible splenic and renal infarcts. Patient was admitted for suspected endocarditis. Blood cultures were +MSSA. Pediatric cardiology ECHO was consistent with mitral valve vegetation consistent with endocarditis and septic emboli.

Resources for more info:


Happy scanning!

  • The US Team