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July 19, 2010

Radiology Quiz Case 2

Arch Otolaryngol Head Neck Surg. 2010;136(7):741. doi:10.1001/archoto.2010.97-a

A 14-year-old white boy presented with an 18-month history of intermittent epistaxis, nasal obstruction, and fatigue. The epistaxis was anterior in location and typically occurred after nose blowing. The patient's medical history was remarkable only for seasonal allergies that were treated with loratadine. He denied previous nasal trauma.

On physical examination, the patient was audibly sonorous, spoke with a hyponasal quality, and assumed an open-mouth breathing position. Anterior rhinoscopy and nasal endoscopy revealed a large mass filling the left naris, with displacement of the septum toward the right (Figure 1). The results of the rest of the general and otolaryngologic examinations were noncontributory. Axial T2-weighted magnetic resonance images (MRIs), fat-saturated postgadolinium T1-weighted MRIs (Figure 2and Figure 3), and a computed tomographic scan (Figure 4) were obtained.

What is your diagnosis?