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Clinical Challenge
Radiology
June 2016

Mass of the Anterior Nasal Septum

Author Affiliations
  • 1Department of Radiology, University of California San Diego School of Medicine, San Diego
  • 2Department of Pathology, University of California San Diego School of Medicine, San Diego
JAMA Otolaryngol Head Neck Surg. 2016;142(6):601-602. doi:10.1001/jamaoto.2015.3978

A man in his mid-60s was referred to the otolaryngology surgery department for evaluation of an incidental deep nasal septal mass discovered on a noncontrast head computed tomographic (CT) study ordered for stroke-like symptoms after a colonoscopy. His only symptom was frontal and ethmoid sinus pressure. He denied difficulty breathing, postnasal drip, rhinorrhea, epistaxis, or anosmia and had no history of sinus or upper respiratory infections. His extensive medical history was notable for congestive heart failure, Ménière’s disease after multiple endolymphatic shunts, a benign parotid tumor (which had been excised), and chronic abdominal pain secondary to pancreatic steatorrhea. Flexible nasal endoscopy confirmed a central posterior bulge in the posterior nasal cavity with normal overlying mucosa and clear nasopharynx. The noncontrast CT bone window showed an expansile anterior nasal septum mass measuring 1.9 × 2.4 cm with internal matrix mineralization (Figure, A-C). Biopsy and magnetic resonance imaging (MRI) were recommended as baseline studies for follow-up, but were not completed. A complete septectomy was performed, which involved near-complete resection of the quadrangular cartilage and resection of the adjacent anterior portion of the periosteum of the vomer bone. A histological specimen is shown in the Figure, D.

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