PMC7530203_01
Paranasal sinuses (PNS).. CT of the paranasal sinuses (PNS) without contrast shows a right nasal mass that obliterates the nasal airway. Mass shows attenuation without calcification. Medially there is a left nasal deviation with bone remodeling. Laterally there is remodeling of the medial antral wall, and the disease extends posteriorly through the choanal region and superiorly into the ethmoidal air cells. There is a secondary opacification of the right sinuses.
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Imaging studies included computed tomography (CT) of the paranasal sinuses that showed a right nasal mass sized eight centimeters causing sinonasal obstruction and underlying sinusitis, but the appearance of the mass was nonspecific (Fig. 1).
Paranasal sinuses (PNS).. MRI of the PNSs shows a large solid polyp filling and expanding the right nasal cavity. The polyp can be seen compressing and displacing the turbinates laterally, with a small polyp present in the middle meatus. There is a secondary obstruction of all the PNSs on the right side with fluid. The nasal septum is deviated to the left side with a patent left nasal cavity and normal turbinates. The PNSs of the left side are all clear.
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The paranasal sinuses on magnetic resonance imaging (MRI) demonstrated a sinonasal angiomatous polyp of the right nasal cavity (Fig. 2).
Angiography.. Right head and neck angiograph with embolization, injection to the right internal carotid artery failed to demonstrate supply to the nasal tumor. Injection to the external carotid artery shows supply from the internal maxillary branches to the nasal tumor. The tumor is moderately to highly vascular.
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The patient had a preoperative embolization of the hemangioma's feeding vessel, which was the internal maxillary artery (Fig. 3).
Post-resection and embolization gross hemangioma appearance.
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The vascular mass was resected en bloc with minimal bleeding (Figure 4).
CT of the paranasal sinuses (PNS) with contrast 1 year post the surgery with no signs of recurrence.
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Histopathological examination revealed a hemangioma of capillary type. one year follow up was satisfactory, and the patient's symptoms totally resolved without any complications (Figs. 5 and 6).
Endoscopic view of right nasal fossa 1 year after the surgery with no signs of recurrence. (arrow: right middle turbinate).
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Histopathological examination revealed a hemangioma of capillary type. one year follow up was satisfactory, and the patient's symptoms totally resolved without any complications (Figs. 5 and 6).