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Clinical Problem Solving: Pathology
November 2002

Pathology Quiz Case 2

Author Affiliations
 

FREDERIC B.ASKINMDWILLIAM H.WESTRAMD

Arch Otolaryngol Head Neck Surg. 2002;128(11):1327. doi:

A 68-YEAR-OLD African American man was referred for evaluation of left-sided nasal obstruction of 1 month's duration. He also noted some mild swelling of the left side of his face. He denied headaches, facial pressure, rhinorrhea, sneezing, epistaxis, decreased sense of smell, or problems with his teeth. Also, he had no history of fever, chills, night sweats, weight loss, or previous nasal problems. He was treated with beclomethasone spray, without relief of symptoms.

His medical history was significant for hypertension, insulin-dependent diabetes, and end-stage renal disease, necessitating hemodialysis. His medications included a prescription multivitamin supplement (Nephrocaps; Fleming & Co, Fenton, Mo), clonidine, nifedipine (Procardia), docusate sodium, calcium carbonate, insulin, and allopurinol. He did not smoke tobacco or drink alcohol.

The patient was in no acute distress. He had left-sided facial swelling that was mildly tender. There were no skin changes over the swelling. Anterior rhinoscopy showed total obstruction of the vestibule. Even after attempts to decongest the nose, a flexible scope could not be passed through the left nostril but was able to be passed through the right nostril, demonstrating a normal nasopharynx and hypopharynx. The results of the rest of the ear, nose, and throat examination were unremarkable, including the absence of lymphadenopathy. The abdomen was soft, without splenomegaly. A computed tomographic scan revealed a unilateral left nasal obstruction and some mild left maxillary, ethmoidal, and frontal sinusitis (Figure 1). A biopsy of the mass was performed (Figure 2).

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