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Clinical Problem Solving: Radiology
January 2007

Radiology Quiz Case 2

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Copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2007

Arch Otolaryngol Head Neck Surg. 2007;133(1):91. doi:10.1001/archotol.133.1.91

A 59-year-old man was admitted to the emergency department with a 24-hour history of left-eye exophthalmos and total loss of vision. He had initially been diagnosed as having an upper respiratory tract infection with intense rhinorrhea and had been treated with intravenous penicillin and methylprednisolone. Physical examination revealed a nasal mass occluding the left nasal cavity and rhinorrhea originating from the middle meatus. Ophthalmologic examination showed an absence of left afferent pupillary reflex, decreased abduction of the left eye, chemosis, and incipient papilledema. There was no light perception. A computed tomographic (CT) scan showed an expanding lesion (isodense to brain) of the left nasal cavity involving the maxillary, ethmoidal, and frontal sinuses and spreading to the left orbit, thereby displacing the left optical nerve laterally and the medial rectus muscle superiorly. There was no thrombosis of the cavernous sinus or intracranial extension. The lateral wall destruction of the left ethmoidal cells can be seen in Figures 1, 2 (axial CT scan), and 3 (coronal reconstruction from the axial CT scan).

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