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Clinical Problem Solving: Radiology
November 2012

Radiology Quiz Case 1

Author Affiliations

University Hospital of Modena, Modena, Italy

Arch Otolaryngol Head Neck Surg. 2012;138(11):1085. doi:10.1001/2013.jamaoto.356a

A 38-year-old woman presented with a 1-year history of right eyelid swelling associated with ipsilateral orbital pain and frontal headache. She also complained of nausea and vomiting over the past 8 months and, subsequently, ptosis of the right eyelid. She had no rhinorrhea, nasal obstruction, or symptoms of sinusitis. The clinical evaluation was negative for nasal masses, and her medical history was unremarkable.

Computed tomography with contrast (Figure 1) was performed, after which T1-weighted (Figure 2) and T2-weighted (Figure 3 and Figure 4) magnetic resonance images were obtained. After the radiologic evaluation, the patient underwent surgery. A combined technique was chosen to completely remove the mass: endoscopic transnasal and frontal external approaches were performed. After the external incision, pathologic tissue was found emerging through the anterior wall of the right frontal sinus. The posterior wall of the sinus appeared completely dehiscent as a result of the erosion caused by the mass; however, the underlying dura was intact. The lesion occupying the frontal sinus was removed; then, an enlargement of the right frontal ostium was performed using an endoscopic transnasal approach.