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Clinical Challenge
February 2016

A Woman With Recurrent Unilateral Epistaxis

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Columbia University College of Physicians and Surgeons, New York, New York
  • 2Department of Otolaryngology–Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
JAMA Otolaryngol Head Neck Surg. 2016;142(2):189-192. doi:10.1001/jamaoto.2015.2939

A woman in her 50s presented with a 3-month history of recurrent right-sided epistaxis. On rigid nasal endoscopy, she was noted to have a smooth, mucosalized, friable mass obstructing the entire right anterior nasal cavity. Maxillofacial computed tomography (CT) without contrast demonstrated a 2.7 × 1.1-cm mass in the right anterior nasal cavity, between the inferior turbinate and nasal septum (Figure, A). Contralateral septal deviation was observed, but there was no evidence of bony erosion or infiltration of the maxillary sinus. Maxillofacial magnetic resonance imaging (MRI) confirmed a well-defined mass filling the right anterior nasal cavity, measuring 2.5 × 2.3 × 1.0 cm, appearing to originate from the submucosal soft tissue of the nasal septum and pushing against the inferior turbinate. The mass appeared heterogeneously hyperintense with several small, irregular signal voids scattered within the lesion on T2-weighted images (Figure, B). On T1-weighted images (Figure, C), the mass appeared isointense, with marked enhancement on T1 postcontrast images sparing a thin peripheral nonenhancing ring, most prominently at the anterior border of the mass (Figure, D). Complete endoscopic excision of the mass was then performed in the operating room.

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