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Clinical Problem Solving: Radiology
April 18, 2011

Radiology Quiz Case 3: Diagnosis

Author Affiliations
 

C. DOUGLASPHILLIPSMD

Arch Otolaryngol Head Neck Surg. 2011;137(4):404-409. doi:10.1001/archoto.2011.42-b

Diagnosis: Organizing hematoma of maxillary sinus (OHMS)

Given the patient's age and sex and the unilaterality of the recurrent epistaxis, the initial leading diagnosis in the differential was juvenile nasopharyngeal angiofibroma causing secondary maxillary sinus opacification. Because there there was no sphenopalatine foramen involvement on imaging, however, infectious, inflammatory, and neoplastic disorders were subsequently considered. In the patient's age group, benign lesions include papillomas, polyps, mucoceles, hemangiomas, pseudotumors secondary to inflammation, fibro-osseous lesions, odontogenic tumors, giant cell granulomas, myxofibromas, and, less commonly, mycetomas. Malignant lesions include rhabdomyosarcoma, undifferentiated carcinoma, adenocarcinoma, fibrosarcoma, and lymphoma. Metastatic tumors, squamous cell carcinoma, minor salivary gland tumors, and melanoma are possible but less common in this age group.1

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