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Clinical Problem Solving: Pathology
March 2005

Pathology Quiz Case

Author Affiliations
 

FREDERIC B.ASKINMDWILLIAM H.WESTRAMD

Arch Otolaryngol Head Neck Surg. 2005;131(3):271. doi:10.1001/archotol.131.3.271

A 47-year-old man presented with a 2-week history of progressively worsening pain and swelling in his right eye, purulent right-sided nasal discharge, and subjective fever. He had been seen by a physician at an outside clinic 1 week earlier and had been placed on a regimen of amoxicillin-clavulanate for presumed acute sinusitis. He was a heavy smoker and had 2 to 3 alcoholic drinks per day. His medical and social histories were otherwise unremarkable.

On examination, the soft tissue overlying the right maxilla was edematous, erythematous, and tender to palpation. Nasal endoscopy revealed purulence as well as a smooth mucosa-lined mass completely obstructing the right nasal cavity. The right eye was proptotic, injected, and chemotic, with restricted extraocular movements in all directions. Visual acuity was mildly impaired in the right eye. Lateral canthotomy with inferior cantholysis was performed because of markedly elevated intraocular pressure in the right eye. The findings of the rest of the physical examination were unremarkable.

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