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Clinical Challenge
July 2016

Patient With Nasal Obstruction

Author Affiliations
  • 1Department of Radiology, Montefiore Medical Center–Albert Einstein College of Medicine, Bronx, New York
JAMA Otolaryngol Head Neck Surg. 2016;142(7):707-708. doi:10.1001/jamaoto.2016.0891

A woman in her 30s presented with chronic bilateral nasal congestion in the absence of facial pressure, pain, paresthesia, bleeding, dysphagia, or voice change. Physical examination demonstrated no lymphadenopathy. The oropharynx and oral cavity were clear. Anterior rhinoscopy demonstrated thick, clear to yellow mucus bilaterally in the nasal cavities and bilateral inferior turbinate hypertrophy. There was right to left nasal septal deviation. Rigid nasal endoscopy demonstrated moderate mucosal edema responsive to topicalization. Thick, clear to yellow mucus was evacuated with suction from the middle meatus and sphenoethmoidal recess, revealing a large, lobulated, flesh-colored mass filling the entire nasopharynx with an irregular surface and firm consistency. The fossae of Rosenmuller were effaced bilaterally. There was no overt surface ulceration or bleeding. Computed tomography (CT) revealed a well-defined, round, 2-cm midline posterior nasopharyngeal mass, situated between the longus colli muscles (Figure, A). The lesion appeared hypodense on CT, without calcification, enhancement, or bony erosion. Magnetic resonance imaging (MRI) (Figure, B-D) demonstrated the lesion to be hypointense on T1 sequence and hyperintense on T2 sequence with mild heterogeneous enhancement. No clival sinus tract was seen. Endoscopic biopsy of this mass was performed.

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