Abstract
We herein report the cases of pneumoparotid that we experienced in our hospital (eight cases were certain, two cases were suspected and two cases were difficult to diagnose) and review the characteristic features of pneumoparotid distinguished from 36 previously reported cases in the pertinent literature. Pneumoparotid was distributed across all ages under 20 years of age. The classification of the causes revealed that the overwhelming majority of pneumoparotid cases were self-induced. Acts related to physical symptoms, such as a cough, resulted in 20% of the cases, while 80% of the cases were due to non-physical symptoms, such as the intention of making the parotid swell through puffing out the cheeks. The latter cases showed stress as a background. We classified the stress into Munchausen syndrome, maladaptation and abnormal habits. Munchausen syndrome comprised 20.8% of the cases with a stress background and was most frequent in children approximately 10 years of age ; maladaptation comprised 45.8% of the cases and was most frequent in children between 10 and 20 years of age ; and abnormal habits comprised 33.3% of the cases and were most frequent in adults. The cases of Munchausen syndrome showed bilateral parotid swelling, the cases of abnormal habits showed unilateral, and the cases of maladaptation showed bilateral and unilateral equally. It generally takes a long time to diagnose pneumoparotid ; therefore many cases were often diagnosed with an infection, such as recurrent parotitis or mumps. The general population typically suffers from mumps once in life, and recurrent parotitis typically occurs under 4 years of age for the first time and seldom over 10 years of age. The characteristic features of pneumoparotid are crepitus and foaming saliva, however, a third of the cases did not show either symptom. Detailed and careful anamnesis is useful to diagnosis such cases. When we suspect pneumoparotid, CT should be first performed. In cases where there is no sign of pneumoparotid, parotid sialography is useful for the diagnosis. Pneumoparotid appears to be more common than previously believed. Thus, this disease should be kept in mind. Overlooking pneumoparotid may mean to miss a patient's cry for help and lose an opportunity to provide mental support.
