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Clinical Problem Solving: Radiology
November 2004

Radiology Quiz Case 1

Author Affiliations
 

R. NICKBRYANMDPATRICIA A.HUDGINSMD

Arch Otolaryngol Head Neck Surg. 2004;130(11):1340. doi:10.1001/archotol.130.11.1340

A 43-year-old woman presented with a 4-year history of “recurrent sinusitis” manifested by headache, facial pain, and foul-smelling nasal drainage. She had been treated with multiple antibiotics over the previous 4 years, with only temporary clearing of her symptoms, which would recur along with “migrainelike” headaches every 2 to 3 months. Her medical history was otherwise unremarkable, and she had no environmental allergies.

Physical examination revealed trace purulent rhinorrhea in the right nasal cavity, and an irregular-appearing, mucosa-lined mass was evident on anterior rhinoscopy. The mass carried a blue tint and nearly filled the anterior nasal vestibule. The nasal septum was deviated toward the left, but appeared intact. The middle meatus and posterior nasal cavities on the right could not be examined with anterior rhinoscopy. The left nasal cavity was clear, with healthy nasal mucosa, normal-sized turbinates, and a clear middle meatus. Rigid endoscopy with a 0° telescope revealed an irregular, friable mass with a granular surface attached to the inferior turbinate. The mass was gritty in texture and tender to palpation, and it bled easily on touch.

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