Radiology Quiz Case 2 | Radiology | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
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November 15, 2010

Radiology Quiz Case 2

Arch Otolaryngol Head Neck Surg. 2010;136(11):1141. doi:10.1001/archoto.2010.190-a

In December 2008, a 5-month-old boy presented with a 1-month history of left nasal obstruction associated with purulent rhinorrhea. His delivery had been uneventful, and his nasal breathing was normal at birth. Rhinoscopy with a flexible endoscope showed a large, reddish, left-sided nasal mass completely occupying the nasal fossa. It bled easily, and its origin was not evident.

Magnetic resonance imaging (MRI) demonstrated an oval mass, measuring 14 × 19 × 17 mm, filling the left nasal cavity with heterogeneously hyperintense signal on T2-weighted images (Figure 1) and hypointense signal on T1-weighted images (Figure 2). After contrast administration, a marked, though incomplete, enhancement was evident on T1-weighted images (Figure 3) and gradient-echo T1-weighted images (Figure 4) and was associated with hypoenhancing areas within the lesion. The mass showed well-defined margins, and the nasal septum and medial maxillary sinus wall were deformed but not infiltrated.

A biopsy was not performed. The infant underwent transnasal endoscopic treatment. Complete excision of the mass, which was located along the inferior portion of the nasal septum, was achieved with a diode laser. No perioperative complications were observed. The patient was discharged from the hospital 2 days after surgery on a regimen of antibiotic therapy (amoxicillin–clavulanate potassium, 25 mg/kg, 2 times per day) and daily nasal washes with saline solution for 10 days. No recurrence was present at endoscopic follow-up.

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