Pleomorphic adenoma

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  Most common parotid space tumor (80%)

  
  
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  Well defined, lobulated, solid, hypoechoic

  
  
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  Homogeneous internal echoes with posterior enhancement

  
  
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  Large tumors more heterogeneous from hemorrhage and necrosis

  
  
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  Intratumoral calcification may occur if longstanding

  
  
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  Malignant transformation if untreated

Warthin tumor

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  Arises in intraparotid lymphoid tissue, 2nd most common benign parotid tumor

  
  
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  Well defined, heterogeneous, hypoechoic

  
  
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  Cystic change, posterior acoustic enhancement

  
  
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  Multiseptated when large

  
  
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  Multicentric in 20%, unilateral or bilateral, malignant change in 1%

Malignant parotid tumors

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  Include mucoepidermoid carcinoma, adenoid cystic and acinic cell carcinoma, and adenocarcinoma

  
  
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  Ill-defined, irregular border, hypoechoic, necrosis, local invasion, and adenopathy

  
  
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  Internal vascularity

  
  
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  Low-grade tumors may mimic benign tumors

Non-Hodgkin lymphoma

Parotid nodal metastasis

Painless or painful cheek mass

Facial nerve paralysis

Evaluate for signs of invasion and regional lymphadenopathy