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Clinical Problem Solving: Pathology
September 2003

Pathology Quiz Case

Author Affiliations
 

FREDERIC B.ASKINMDWILLIAM H.WESTRAMD

Arch Otolaryngol Head Neck Surg. 2003;129(9):1015. doi:10.1001/archotol.129.9.1015

A 39-YEAR-OLD woman presented with a 3-year history of total nasal obstruction. She also complained of facial pain and postnasal drainage that had been increasing for several months. She denied any history of facial trauma but did admit to a long history of intermittent cocaine abuse. She denied any symptoms of epistaxis, epiphora, otalagia, diplopia, or weight loss. The rest of her medical and surgical history was unremarkable.

Nasal examination revealed bilateral total nasal stenosis. The nasal cavities ended in blind mucosal-covered bony pits approximately 1 cm from the anterior rim of the nares. An anterior septal perforation was also noted. No lymphadenopathy was noted in the neck. The findings of the rest of the head and neck examination were normal. A computed tomographic scan of the head and neck region (Figure 1) revealed bilateral bony thickening of the nasal floor and medial maxillary walls, obstructing the choanae. Routine laboratory evaluation revealed all values to be within normal limits, including serum calcium, phosphate, total protein, albumin, and alkaline phosphatase levels.

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