CT Imaging of Head and Neck Lupus Panniculitis

Abstract

SUMMARY:Lupus panniculitis (LP) or lupus erythematosus profundus (LEP) is a lupus-associated dermatologic condition predominantly affecting young to middle-aged women in which the deep dermis and subcutaneous fat are mainly involved. The lesions are usually located on the forehead, cheeks, proximal aspect of the limbs, and buttocks, though cases have occasionally been reported with orbital, breast, and salivary gland involvement. Descriptions of imaging findings of LP are very scarce in the literature. We describe the CT scan imaging features of the case of a patient with head and neck LP. Lupus panniculitis (LP) is a very rare condition the imaging features of which are extremely scarce in the literature. We describe the CT scan imaging features of this rare disease entity in a patient. Case ReportA 28-year-old African American woman developed tender indurated lesions on the left arm and in the right face, extending from the parotid area around the angle of the jaw toward the chin. Two years previously, biopsy results of an indurated area on her face revealed no evidence of a neoplasm. She had been previously diagnosed with systemic lupus erythematosus (SLE) when she was found to have positive antinuclear antibody results in the context of a pregnancy ending in a stillbirth.Biopsy results of the lesion on her arm revealed panniculitis. It was recommended that she initiate treatment with steroids in combination with mycophenolate for lupus panniculitis. After 2 months, she experienced swelling of the bilateral neck. On physical examination, the lesion in the area of the right parotid was unchanged. There were new subcutaneous nodules in the neck bilaterally and in the submental area. The skin overlying these nodules was fixed to them. There was no palpable adenopathy.A contrast-enhanced CT scan of the neck demonstrated diffuse, superficial soft tissue infiltration of the right masticator space fat, extending into the fat overlying the anterior and lateral margins of the parotid gland. The lesion was both superficial and deep to the platysma muscle. There was extension into the posterior buccal space fat (Fig 1). The soft tissue infiltration lay superficial to both the masseter and temporalis muscles. The fat plane between the muscles was also ill defined. The right parotid duct was within the lesion (Fig 2). The process extended inferiorly into the right submandibular space, infiltrating the fat plane surrounding the right submandibular gland (Fig 3). The lesion produced an indrawing, cicatrizing effect rather than an outward bulge, which was illustrated on 3D surface-rendered images of the face (Fig 4). There was no adjacent osseous abnormality.There were mildly enlarged right intraparotid and level II lymph nodes and scattered bilateral shotty cervical lymph nodes, more prominent on the right side. The left parotid and submandibular salivary glands appeared normal. Extranodal lymphoid tissue in the Waldeyer ring and thyroid gland also appeared normal. Discussion LP is a rare skin condition, the clinical findin...

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