it is generally overlooked by clinicians and otolaryngologists ( even in countries where tuberculosis is endemic ) with most of cases undergoing unnecessary surgeries . correct radiological interpretation can help in differentiating tuberculous involvement from benign neoplasms ( pleomorphic adenoma ) with which it is commonly confused . a 45-years - male presented with mass in right parotid region , progressively increasing for last 1 year . no abnormality was found on physical examination . local examination revealed a palpable 5  4  4.5 cm firm to hard lobulated mass in the right parotid region with no obvious systemic complaints . ultrasound examination [ figure 1 ] using a linear array transducer showed diffusely enlarged right parotid gland with heterogeneously hypoechoic echotexture with no calcification or cystic degeneration . contrast - enhanced computed tomography of neck [ figure 2 ] showed right parotid enlargement with illdefined hypodense lesions . a provisional diagnosis of neoplasm was made . fine needle aspiration cytology ( fnac ) done from the lesion proved to be tuberculosis [ figure 3 ] with positive stain for acid fast bacilli ( afb ) . retrospective analysis of radiological images provided clue to the lesion being infective ( tuberculous ) rather than neoplastic . the patient was successfully treated with standard anti - tubercular regimen for 6 months and showed complete resolution of the disease . usg of right parotid region showed diffusely enlarged parotid gland with heterogeneously hypoechoic echotexture of parotid parenchyma and multiple focal anechoic areas with thick walls ( arrows ) contrast enhanced ct neck showed enlarged right parotid gland with multiple central hypodense areas showing peripheral enhancement ( arrows ) fine needle aspiration cytology showing an epithelioid cell granuloma , necrotic fragment and a tiny cluster of salivary ductal epithelial cells ( arrow ) in a background comprising of lymphocytes and histiocytes ( hematoxylin and eosin 20 ) extrathoracic involvement in tuberculosis occurs in approximately 20% of cases with tuberculous lymphadenitis being most common form involving cervical lymph nodes . salivary gland infection is believed to be direct extension of the bacilli from the oral cavity via the gland ductal system ( due to preceding tooth or tonsil infection ) . clinical presentation can be acute in form of parotitis or chronic as progressively increasing mass of months to years duration . preoperative diagnosis can be suggested by imaging methods with confirmation of diagnosis by fnac / biopsy . imaging modalities for evaluating parotid and other salivary gland include ultrasound , computed tomography ( ct ) and magnetic resonance imaging ( mri ) . in addition , they are very useful in showing whether a palpable lesion arises within the parotid gland or is periparotid in location . sonographically parenchymal type presents as diffusely enlarged gland showing heterogeneously hypoechoic parenchyma with focal hypoechoic or anechoic areas within the gland . periparotid type presents with enlarged hypoechoic nodes in periphery of gland with parenchyma showing hyperechogenicity . neoplasms appear as well defined hypoechoic nodule with necrosis or hemorrhage seen as cystic areas with significant color flow with tumour substance on colour doppler imaging . ct findings of a solid nodule with homogeneous enhancement , multiloculated rim enhancing nodule with central lucency and contrast enhancing solid nodule with an eccentric nonenhancing microcyst have been reported . specific ct findings are multiple round , smooth thick , walled rim enhancing lesion with central lucency within parotid with parenchyma showing diffuse enhancement with filling defects . two typical patterns of tuberculous lymphadenitis are multilocated nodal mass with thick smooth - walled enhancing rims and central lucency and another pattern of low - density central mass with thick corrugated enhancing rim . non - specific pattern are homogeneously enhanced masses and thin rim enhancing masses . on mri lesions are hypointense on t1-weighted images , hyperintense on t2-weighted images with homogeneous postcontrast enhancement . fnac or biopsy can be done to confirm the diagnosis with identification of bacilli by ziehl - neelsen ( zn ) staining for afb or culture methods . index case has been treated with antitubercular therapy with near complete resolution of parotid swelling . the differential diagnosis of parotid mass lesion includes generally benign and malignant neoplasm of the parotid gland ; however , tuberculosis and sarcoidosis should also be considered . to conclude , parotid tuberculosis is an uncommon entity with atypical clinical presentations . it should be kept as differential diagnosis in solitary slowly enlarging parotid swelling with further characterization of the lesion by various imaging modalities . correct radiological interpretation can rule out benign parotid neoplasm in most of cases and provide clue toward tubercular pathology .
parotid gland involvement in tuberculosis is rare . we present a case of middle aged male presenting with parotid swelling for 1 year and 
 diagnosed to have parotid tuberculosis on fine needle aspiration cytology . 
 a brief review of radiological findings in tuberculous parotitis is discussed which can help in correct interpretation and timely diagnosis , and thus avoiding unnecessary parotidectomies .