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Clinical Challenge
Pathology
December 6, 2018

Anterior Nasal Cavity Mass in a Neonate

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, University of Minnesota, Minneapolis
  • 2Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
  • 3Ear, Nose, and Throat and Facial Plastic Surgery, Children’s Minnesota, Minneapolis
JAMA Otolaryngol Head Neck Surg. Published online December 6, 2018. doi:10.1001/jamaoto.2018.3123

A newborn twin girl was referred to the pediatric otolaryngology clinic at a tertiary pediatric hospital for evaluation of a left-sided nasal mass causing nasal obstruction and difficulty breathing, especially with feeding (Figure 1A). She was born at 36 weeks’ gestation and spent 10 days in the neonatal intensive care unit. Her parents noted that the lesion was present at birth and she always seemed congested on the left side. There was no report of clear drainage. Physical examination showed an approximately 1-cm, firm, pedunculated polypoid mass in the anterior nasal cavity at the vestibule. The base was located just anterior to the septum and encompassed nearly the entire left nasal cavity. There was no fluid in the mass, and there was a negative Furstenberg sign. Nasal endoscopy was performed in the clinic, and there were no additional masses or mucosal abnormalities. The choana was patent. The patient was also noted to have left eye ptosis and left preauricular branchial remnants but no other significant abnormalities on examination. Magnetic resonance imaging was performed (Figure 1B) and showed a 0.8 × 0.5–cm hyperintense mass on T1-weighted images, suggesting a fatty component and no intracranial tract.

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