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Clinical Problem Solving: Pathology
September 20, 2010

Pathology Quiz Case 1

Author Affiliations

Copyright 2010 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2010

Arch Otolaryngol Head Neck Surg. 2010;136(9):929. doi:10.1001/archoto.2010.137-a

A 42-year-old man presented with left-sided facial pressure and nasal airway obstruction. Despite a partial response to oral antibiotic therapy, he developed periorbital edema and erythema and was hospitalized. On physical examination, his left eye appeared proptotic. Nasal endoscopy demonstrated a fleshy mass in the left nasal cavity that extended superiorly toward the roof of the ethmoid and obstructed the osteomeatal complex.

Computed tomography revealed pansinusitis. Magnetic resonance imaging demonstrated a large soft-tissue mass centered within the left nasal cavity (Figure 1). The mass extended superiorly to the anterior ethmoid air cells and intracranially through the left cribriform plate. Abnormal enhancement was observed along the dura and in the region of the olfactory tracts. An axial T1-weighted postgadolinium image showed that the mass caused severe lateral bowing of the left medial orbital wall, with displacement of the medial rectus and left globe (Figure 2).