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Clinical Problem Solving: Radiology
June 2013

Radiology Quiz Case 2

JAMA Otolaryngol Head Neck Surg. 2013;139(6):647. doi:10.1001/jamaoto.2013.3179a

A 32-year-old man presented to the otolaryngology clinic with a 1-year history of complaints of bilateral nasal obstruction. Medical treatment at an outside institution, including nasal steroids, had failed to improve his condition. His medical history was remarkable for closed reduction of a nasal bone fracture 10 years prior to presentation. A physical examination revealed lateral expansion of the nasal bones with a widened nasal vault and dorsum. Nasal endoscopy revealed a submucosal septal mass that was “bowing” out into both nasal cavities and appeared to be predominantly located in the dorsal portion of the mid septum. A computed tomographic scan of the sinuses revealed a round, smooth, homogeneous mass in the dorsal septum without opacification of the paranasal sinuses or any other abnormalities (Figure 1 and Figure 2). A biopsy specimen of the widened portion of the nasal septum demonstrated normal respiratory mucosa.

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