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Choi KY, Choi S, Jeong S, Won TB. Successful Endoscopic Transsphenoidal Approach Treatment of Sphenoid Sinus Organized Hematoma Causing Visual Deficit: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1802. [PMID: 37893520 PMCID: PMC10608076 DOI: 10.3390/medicina59101802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/20/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023]
Abstract
Background: Organized hematoma in the sphenoid sinus is rare, but serious complications, such as visual deficits, can occur. Three such case reports have been published previously in the literature; however, none have achieved complete recovery of the vision. Case presentation: A 69-year-old male patient was referred to the ear, nose, and throat department with an expansile soft tissue mass filling the right sphenoid sinus and blurry vision in his right eye. Complete mass removal was achieved by a wide opening of the sphenoid sinus via an endoscopic transsphenoidal approach, followed by cauterization of the feeding artery and coverage by a nasoseptal flap. The patient's vision was restored after the operation, and he declared no visual symptoms until the latest follow-up (one year after the surgery). Conclusions: Complete excision with an endoscopic endonasal transsphenoidal approach can restore visual deterioration caused by a sphenoid sinus organized hematoma.
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Affiliation(s)
- Kyu Young Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea; (K.Y.C.); (S.C.)
| | - Sun Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea; (K.Y.C.); (S.C.)
| | - Suji Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Tae-Bin Won
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
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2
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Sinha D, Dasegowda G, Gayatri Y, Viswamitra S. Sino Nasal Organizing Hematoma Masquerading as Sino-Nasal Neoplasm. Indian J Otolaryngol Head Neck Surg 2022; 74:4669-4672. [PMID: 36742895 PMCID: PMC9895526 DOI: 10.1007/s12070-021-02982-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/08/2021] [Indexed: 02/07/2023] Open
Abstract
Sino-nasal organized hematoma (OH) is an uncommon, benign condition of the sinuses. It mimics neoplasm in its clinical presentation as well on imaging appearance. Careful evaluation of the clinical history and imaging features is essential to avoid misdiagnosis. We present an interesting case of sino-nasal organizing hematoma in a 26-year-old male patient, masquerading as sino-nasal neoplasm.
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Affiliation(s)
- Dimpi Sinha
- Department of Radiology, Shri Sathya Sai Institute of Higher Medical Sciences, EPIP Zone, Whitefield, Bengaluru, 560066 India
| | | | - Yeduvaka Gayatri
- Department of Radiology, Shri Sathya Sai Institute of Higher Medical Sciences, EPIP Zone, Whitefield, Bengaluru, 560066 India
| | - Sanjay Viswamitra
- Department of Radiology, Shri Sathya Sai Institute of Higher Medical Sciences, EPIP Zone, Whitefield, Bengaluru, 560066 India
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3
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Endoscopic Surgical Treatment of Maxillary Sinus Organized Hematoma. J Craniofac Surg 2021; 32:e687-e689. [PMID: 33840759 DOI: 10.1097/scs.0000000000007582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The purpose of this study was to analyze the clinical characteristics and treatment outcomes of patients who underwent endoscopic surgery for a maxillary sinus organized hematoma during a 15-year period in our hospital. METHODS The authors analyzed 25 patients who underwent endoscopic surgery for a maxillary sinus organized hematoma from January 2004 to December 2019. RESULTS Twenty-five patients with a maxillary sinus organized hematoma underwent endoscopic surgical treatment and complete removal of the maxillary sinus organized hematoma was achieved in all cases. The main symptoms were nasal bleeding in 14 patients, followed by a nasal obstruction in nine, and facial swelling in 2. Of the 25 patients, 13 underwent endoscopic medial maxillectomy and 12 underwent endoscopic sinus surgery. There were no major surgical complications or recurrences. CONCLUSION The authors demonstrated that endoscopic surgery is a safe and reliable treatment method for a maxillary sinus organized hematoma.
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Lin GC, Wells Porrmann J, Paz M, Moshel YA, LeBenger J, Benitez RP. Organized Hematoma of the Sphenoid Sinus With Acute Blindness: Insight Into Pathogenesis of Disease. EAR, NOSE & THROAT JOURNAL 2020; 99:605-609. [PMID: 32692289 DOI: 10.1177/0145561320941959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Sinonasal organized hematomas (OHs) are rare lesions that primarily localize to the maxillary sinus. The rate of growth of these masses has not been described in the literature. We present a case of a 59-year-old gentleman with polyostotic fibrous dysplasia who presented with acute loss of vision in the left eye from an expanding OH of the sphenoid sinusitis. After expanded endonasal, transpterygoid approach and debulking, patient experienced significant vision improvement. Close follow-up imaging preoperatively allowed radiologic documentation of the rate of OH growth and this is presented in detail.
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Affiliation(s)
- Giant C Lin
- Department of Otolaryngology-Head and Neck Surgery, Summit Medical Group, NJ, USA
| | - Jade Wells Porrmann
- Department of Otolaryngology-Head and Neck Surgery, Summit Medical Group, NJ, USA
| | - Melody Paz
- Department of Otolaryngology-Head and Neck Surgery, Summit Medical Group, NJ, USA
| | - Yaron A Moshel
- Atlantic NeuroSurgical Specialists, Morristown Medical Center, Morristown, NJ, USA
| | - Jeffrey LeBenger
- Department of Otolaryngology-Head and Neck Surgery, Summit Medical Group, NJ, USA
| | - Ronald P Benitez
- Atlantic NeuroSurgical Specialists, Morristown Medical Center, Morristown, NJ, USA
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Eissa L, Eid M, Razek AAKA. MR and CT imaging features of sino-nasal organized hematomas. Oral Radiol 2020; 37:297-304. [PMID: 32462337 DOI: 10.1007/s11282-020-00450-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 05/17/2020] [Indexed: 11/26/2022]
Abstract
AIM To describe the MR and CT imaging features of organized hematomas [OH]. METHODS A retrospective analysis of MR imaging and CT of eight patients [6 male, 2 females; age range is 6-86 years] with pathological proven OH was performed. Routine contrast MR and CT scan were done for all patients, and diffusion-weighted imaging and dynamic contrast CT were done for only five patients. Imaging analysis was done for the signal intensity, the enhancement pattern at MR imaging, the ADC value at DWI, bone remodeling at CT, and the neo-vascularization at dynamic contrast CT. RESULTS OH revealed T2 hypo-intense of the matrix in all patients with complete [n = 3] and incomplete [n = 5] marginal hypo-intensity rim. The lesions revealed a frond-like pattern of contrast enhancement of the central part of the lesion that associated with a peripheral rim of contrast enhancement. OH revealed unrestricted diffusion with high ADC value [1.7-2.5 × 10-3 cm2/s] in 5 patients. CT scan showed geographic bone remodeling and thinning of the nasal turbinates, and the sinus wall and contrast CT showed neo-vascularization with frond-like branching arteries of the central part of the lesions in five patients. CONCLUSION We conclude that MR and CT imaging findings can help in the diagnosis of OH.
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Affiliation(s)
- Lamya Eissa
- Department of Diagnostic and Interventional Radiology, Alexandria Faculty of Medicine, Alexandria, 21131, Egypt
| | - Mohamed Eid
- Department of Diagnostic and Interventional Radiology, Alexandria Faculty of Medicine, Alexandria, 21131, Egypt
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Wang X, Liu Y, Chen Q, Xian J. Evaluation of multiparametric MRI differentiating sinonasal angiomatous polyp from malignant tumors. Neuroradiology 2019; 61:891-896. [PMID: 31119344 DOI: 10.1007/s00234-019-02225-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 05/09/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Sinonasal angiomatous polyps (SAPs) can be misdiagnosed as malignant tumors due to aggressive clinical behaviors. The purpose of this study was to evaluate the diagnostic accuracy of multiparametric MRI in differentiating SAPs from malignant tumors. METHODS This retrospective study included 31 patients with pathologically proven SAPs and 36 patients with malignant tumors in maxillary sinus and nasal cavity. All the patients underwent conventional MRI and dynamic contrast-enhanced (DCE) MRI on 3T MR scanners. Diffusion-weighted (DW) MR imaging was performed in 45 patients. All the MR images were retrospectively analyzed independently by two authors. RESULTS Significant differences were found in T1 homogeneity, T2 signal intensity ratio, peripheral hypointense rim on T2WI, and soft tissue infiltration between SAP and malignant tumors (P = 0.004, < 0.001, < 0.001, and = 0.001, respectively). SAPs usually show heterogeneous signal intensity on T1WI, peripheral hypointense rim on T2WI, and higher T2 signal intensity ratio. The tumor size of SAP (4.01 ± 1.08 cm) was slightly smaller than that of malignant tumors (4.56 ± 1.12 cm) (P = 0.045). There were significant differences in DCE-MRI parameters including Tpeak, CImax, WR, TIC types, and progressive enhancement (P = 0.009, < 0.001, = 0.001, = 0.001, and < 0.001, respectively) between SAPs and malignant tumors. All the 31 SAPs showed progressive enhancement on DCE-MRI, while none of the malignant tumors showed progressive enhancement (accuracy 100%). The mean ADC of SAP (1.75 ± 0.30 × 10-3 mm2/s) was higher than that of malignant tumors (1.18 ± 0.31 × 10-3 mm2/s) (P < 0.001). CONCLUSION Multiparametric MRI showed high diagnostic performance in differentiating SAPs from malignant tumors. Progressive enhancement on DCE-MRI is the most effective feature of SAP.
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Affiliation(s)
- Xinyan Wang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Ying Liu
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.,Department of Medical Imaging Technology, College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, Fujian, China
| | - Qinghua Chen
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Junfang Xian
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
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Liu Q, Wu J, Li C, Wang S. The diagnosis and treatment strategy of occipital skull mass in hemophilic patients: a rare case report and literature review. Chin Neurosurg J 2019; 5:8. [PMID: 32922908 PMCID: PMC7398374 DOI: 10.1186/s41016-019-0155-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 03/11/2019] [Indexed: 11/24/2022] Open
Abstract
Background Cranial hemophilic pseudotumor (cHPT) is a very rare disease, which is easy to misdiagnose. It is also difficult to manage such patients. We reported the first case of occipital cHPT. Case presentation Here, we presented a rare case of an occipital bone mass in a 3-year-old boy who was diagnosed with hemophilia A. The mass was misdiagnosed as an aneurysmal bone cyst by pathological examination. After resection, the patient underwent one-stage cranioplasty. However, the patient was admitted again for hematoma caused by an invasive procedure. A second surgery and one-stage cranioplasty were performed at the same time. A follow-up 3 months after discharging showed the patient was uneventful, and the titanium mesh was well fixed. Conclusion The diagnosis of cHPT requires the combining of history, radiological examination, and pathological examination. Resection is the best choice for symptomatic cHPT. Replacement treatment and less invasive treatment can make perioperative management safer. One-stage cranioplasty for resection of an occipital cHPT can improve the quality of life.
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Affiliation(s)
- Qingyuan Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070 China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
| | - Jun Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070 China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
| | - Chunde Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070 China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070 China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
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8
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Varghese L, Mukhopadhyay S, Mehan R, Kurien R, Thomas M, Rupa V. Sinonasal organising haematoma - a little known entity. Braz J Otorhinolaryngol 2018; 85:698-704. [PMID: 30060926 PMCID: PMC9443051 DOI: 10.1016/j.bjorl.2018.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/22/2018] [Accepted: 05/29/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction Sinonasal organising haematoma is a recently described, rare, benign inflammatory condition, which closely resembles malignancy in its clinical presentation. Objective To describe the clinical features of organising haematoma and to review the evolution of surgical options successfully used. Methods A retrospective review of charts of all patients with a histopathological diagnosis of sinonasal organising haematoma was performed. Results Six (60%) of the 10 patients were male with a mean age of 47.4 years. All patients had unilateral disease with recurrent epistaxis as the presenting symptom. Maxillary sinus was the most commonly involved sinus. There was no history of trauma in any of the patients. Hypertension (80%) was the most commonly associated comorbidity. Contrast-enhanced CT scan of the paranasal sinuses showed heterogeneous sinus opacification with/without bone erosion. Histopathological examination was diagnostic. Complete endoscopic excision was done in all patients resulting in resolution of the disease. Conclusion Awareness of this relatively new clinical entity and its evaluation and treatment is important for otolaryngologists, maxillofacial surgeons and pathologists alike. Despite the clinical picture of malignancy, histopathological features of benign disease can safely dispel such a diagnosis.
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Affiliation(s)
- Lalee Varghese
- Christian Medical College, Department of Otorhinolaryngology, Vellore, India.
| | | | - Raghav Mehan
- Christian Medical College, Department of Otorhinolaryngology, Vellore, India
| | - Regi Kurien
- Christian Medical College, Department of Otorhinolaryngology, Vellore, India
| | - Meera Thomas
- Christian Medical College, Department of Pathology, Vellore, India
| | - V Rupa
- Christian Medical College, Department of Otorhinolaryngology, Vellore, India
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Choi YR, Kim JH, Min HS, Won JK, Kim HJ, Yoo RE, Kang KM, Park SW, Yun TJ, Choi SH, Sohn CH, Rhim JH, Kim SC, Ryu JW, Na DG. Acute invasive fungal rhinosinusitis: MR imaging features and their impact on prognosis. Neuroradiology 2018; 60:715-723. [DOI: 10.1007/s00234-018-2034-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/04/2018] [Indexed: 12/29/2022]
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10
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Imaging features of benign mass lesions in the nasal cavity and paranasal sinuses according to the 2017 WHO classification. Jpn J Radiol 2018; 36:361-381. [DOI: 10.1007/s11604-018-0739-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/17/2018] [Indexed: 12/11/2022]
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A Case of Organizing Hematoma in a Maxillary Sinus After Reconstruction of a Blow-Out Fracture. J Craniofac Surg 2018; 28:1040-1041. [PMID: 28582957 DOI: 10.1097/scs.0000000000003788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A 36-year-old man presented because of nasal obstruction, rhinorrhea, and postnasal drip. The patient had undergone reconstruction of a blow-out fracture of the orbital floor 12 years before and had sinusitis that likely had resulted from implant migration into the maxillary sinus. The inflammation was successfully resolved, and the implant was removed through a minimally invasive endoscopic sinus surgery technique. On pathologic examination, an organizing hematoma was identified as the cause of the lesion. Pre- and postoperational paranasal sinus computed tomography images were taken to compare the anatomy of the sinus before and following surgery.
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Sinonasal organised haematoma: clinical features and successful application of modified transnasal endoscopic medial maxillectomy. The Journal of Laryngology & Otology 2017; 131:696-701. [PMID: 28597806 DOI: 10.1017/s0022215117001256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Although organised haematoma often induces bone thinning and destruction similar to malignant diseases, the aetiology of organised haematoma and the optimal treatment remain unclear. This paper presents the clinical features of individuals with organised haematoma, and describes cases in which a novel modified approach was successfully applied for resection of organised haematoma in the maxillary sinus. METHOD Pre-operative examination data were evaluated retrospectively. Modified transnasal endoscopic medial maxillectomy was employed. RESULTS Fourteen patients with organised haematoma were treated. Contrast-enhanced computed tomography showed heterogeneous enhancement in all patients. Eight patients underwent modified transnasal endoscopic medial maxillectomy, without complications such as facial numbness, tooth numbness, facial tingling, lacrimation and eye discharge. Dissection of the apertura piriformis and anterior maxillary wall was not necessary for any of these eight patients. No recurrence was observed. CONCLUSION Pre-operative examinations can be helpful in determining the likelihood of organised haematoma. Modified transnasal endoscopic medial maxillectomy appears to be a safe and effective method for organised haematoma resection.
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Pang W, Hu L, Wang H, Sha Y, Ma N, Wang S, Liu Q, Sun X, Wang D. Organized Hematoma: An Analysis of 84 Cases with Emphasis on Difficult Prediction and Favorable Management. Otolaryngol Head Neck Surg 2016; 154:626-33. [PMID: 26861229 DOI: 10.1177/0194599815625956] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 12/16/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To characterize features of organized hematoma (OH) that may cause considerable diagnostic difficulties. STUDY DESIGN Case series with chart review. SETTING Tertiary medical center. SUBJECTS AND METHODS Eighty-four patients with pathologically confirmed OH over a 10-year period were retrospectively reviewed for clinical features, imaging findings, pathologic characteristics, and treatment modalities. RESULTS This study included 39 males and 45 females who presented with frequent epistaxis and nasal obstruction. There were 62 (74%) patients >40 years old (mean, 50; range, 9-81). OH mainly originated in the maxillary sinus (n = 82) or nasal cavity (n = 2) unilaterally, and most were expansile masses (n = 73) that extended into nasal cavity (n = 71) or choanae (n = 17). Several lesions were locally aggressive and simulated a malignant process that involved the ethmoid sinus (n = 22), orbit (n = 11), pterygopalatine fossa (n = 16), infratemporal fossa (n = 9), cheek (n = 3), and hard palate (n = 3). Internal architecture on computed tomography (CT) scans showed OH with expansile remodeling of the maxillary wall (82.1%) and smooth bony destruction (70.2%), whereas T2-weighted magnetic resonance (MR) images showed inhomogeneity with a notable hypointense peripheral rim in all lesions. CT and MR contrast-enhanced images revealed patchy heterogeneous enhancement that could be interpreted according to histopathologic findings of hemorrhage and neovascularization. OH was successfully removed with endoscopic surgery, although 5 cases recurred. CONCLUSIONS OH can be successfully treated by endoscopic surgery. CT and MR examination provide characteristic findings for prediction and careful surgical planning.
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Affiliation(s)
- Wenhui Pang
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Li Hu
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Huan Wang
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Yan Sha
- Department of Radiology, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Na Ma
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Shuyi Wang
- Department of Pathology, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Quan Liu
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Xicai Sun
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Dehui Wang
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
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Park YK, Kim KS. Organizing Hematoma of the Maxillary Sinus Mimicking Malignancy Diagnosed by Fluorodeoxyglucose Positron-Emission Tomography (FDG PET/CT): A Case Report. IRANIAN JOURNAL OF RADIOLOGY 2015; 12:e18924. [PMID: 26587203 PMCID: PMC4644966 DOI: 10.5812/iranjradiol.18924] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 06/16/2014] [Accepted: 08/02/2014] [Indexed: 11/26/2022]
Abstract
Organizing hematoma of the paranasal sinuses is a diagnostic dilemma clinically and radiographically, mimicking benign or malignant neoplastic processes. Although the diagnostic rate of this disease has increased as characteristic imaging findings are somewhat elucidated, endoscopic examination, preoperative biopsy, and computed tomography (CT) imaging do not give helpful information in differentiating these lesions from malignant neoplastic processes. A 55-year-old man presented with a 4-month history of recurrent nasal bleeding. He also complained of a left-sided nasal obstruction. CT findings were highly suggestive of a malignant tumor of the maxillary sinus. However, based on fluorodeoxyglucose F18 positron-emission tomography (PET/CT) and magnetic resonance imaging (MRI), the provisional diagnosis of benign tumor rather than malignancy was made. Complete resection of the mass was achieved by simple transnasal endoscopic surgery using the Caldwell-Luc approach. Organizing hematoma of the maxillary sinus was diagnosed by histopathologic evaluation. The clinical, radiological, and histopathologic findings of the patient are presented. In this report, we have presented 18FDG-PET findings of organized hematoma of the maxillary sinus (OHMS) that showed an increased FDG uptake in the peripheral rim of the mass with central photopenia. To our knowledge, this is the first case report in the literature reporting FDG-PET/CT findings of OHMS. Careful interpretation of metabolic (FDG-PET/CT) and anatomic (CT and MRI) images should be performed to accurately characterize the expansile lesion of the maxillary sinus in order to increase specificity and reduce equivocal findings significantly.
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Affiliation(s)
- Yong Kyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea
- Corresponding authors: Kyung Soo Kim, Department of Otorhinolaryngology-Head and Neck Surgery,Chung-Ang University Hospital, College of Medicine, Chung-Ang University, P. O. Box: 156-755, Seoul, Korea. Tel: +82-262991765, Fax: +82-28251765, E-mail:
| | - Kyung Soo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea
- Corresponding authors: Kyung Soo Kim, Department of Otorhinolaryngology-Head and Neck Surgery,Chung-Ang University Hospital, College of Medicine, Chung-Ang University, P. O. Box: 156-755, Seoul, Korea. Tel: +82-262991765, Fax: +82-28251765, E-mail:
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Hur J, Kim JK, Byun JS, Lee WJ. Imaging characteristics of sinonasal organized hematoma. Acta Radiol 2015; 56:955-9. [PMID: 25024439 DOI: 10.1177/0284185114542364] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 06/13/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Sinonasal organized hematoma is a rare benign disease that may be mistaken for malignancy. PURPOSE To define the imaging characteristics of sinonasal organized hematoma. MATERIAL AND METHODS We retrospectively reviewed computed tomography (CT) images of eight patients (4 male patients, 4 female patients; mean age, 40 years; range, 9-83 years) with pathologically proven sinonasal organized hematomas; magnetic resonance imaging (MRI) was performed in one patient among them. The following lesions characteristics were analyzed: size, shape, location, expansile nature, density, signal intensity, internal structure, enhancement pattern, and surrounding bony wall change. RESULTS The lesion sizes were in the range of 2-5.2 cm (mean, 3.55 cm), and the shapes were lobular, lumpy, or nodular. They were located in the nasal cavity (n = 1), maxillary sinuses (n = 2), or both nasal cavities and maxillary sinuses (n = 5). Expansile lesions with locally aggressive margins were observed in two cases. All lesions were hyperdense on precontrast CT scans; the smaller lesions showed even hyperdensity, whereas the larger lesions showed uneven density. The signal intensity was mixed on MRI, consisting of hemorrhage, fibrosis, and neovascularization. Papillary or frond-like enhancement was noted after contrast injection. All cases showed smooth erosion of the medial walls of the maxillary sinuses, and the epicenters were the secondary maxillary ostia. Two lesions showed erosion of the lateral walls of the maxillary sinuses and were expansile in nature. Non-hemorrhagic polyps accompanied the organized hematomas in three cases. CONCLUSION Although sinonasal organized hematoma can be mistaken for a malignant tumor, the following characteristic imaging findings facilitate the diagnosis of an organized hematoma: erosion of the bony sinus walls, markedly heterogeneous signal intensity, and papillary or frond-like enhancement.
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Affiliation(s)
- Joonho Hur
- Department of Radiology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jae Kyun Kim
- Department of Radiology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
- Department of Radiology, Kangwon National University College of Medicine, Chuncheon, Republic of Korea
| | - Jun Soo Byun
- Department of Radiology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Woong Jae Lee
- Department of Radiology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
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Abstract
HISTORY A 15-year-old boy presented to the emergency department with intractable epistaxis. He had a prior history of epistaxis typically lasting 5-10 minutes and consisting of up to four episodes per year for several years. Otherwise, the patient had no relevant medical history, and he denied having prior trauma, surgery, bleeding diathesis, fever, chills, or vision changes. Likewise, the patient had no relevant family history. The patient's coagulation panel was unremarkable and included a prothrombin time of 15.4 seconds, an international normalized ratio of 1.2, and a partial thromboplastin time of 29.3 seconds. A thin-section unenhanced sinus computed tomography (CT) examination was performed. In addition, magnetic resonance (MR) imaging of the sinuses without and with intravenous contrast material was performed. The epistaxis was treated with nasal packing, which prevented further bleeding. Biopsy of the lesion was subsequently performed.
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Affiliation(s)
- Daniel Thomas Ginat
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637 (D.T.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (G.M.); and Massachusetts Eye and Ear Infirmary, Boston, Mass (G.M.)
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17
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Choi SJ, Seo ST, Rha KS, Kim YM. Sinonasal organized hematoma: Clinical features of seventeen cases and a systematic review. Laryngoscope 2015; 125:2027-33. [PMID: 25682739 DOI: 10.1002/lary.25200] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 12/20/2014] [Accepted: 01/15/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Organized hematoma (OH) is a rare non-neoplastic disease. We studied the clinical characteristics of 17 patients with sinonasal OH and those of 75 cases in the English literature. STUDY DESIGN Retrospective review of medical records and systematic review of the literature on OH. METHODS Comprehensive review of the English-language literature on OH was performed. We screened all eligible cases based on initial features, and 75 eligible cases found in 15 publications were analyzed. We also retrospectively analyzed and compared medical records of 17 patients diagnosed with pathologically proven sinonasal OH. Data such as demographics, clinical characteristics, pathologic features, radiologic findings, treatment modalities, and follow-up results were compared to the 75 previously mentioned cases. RESULTS Fifteen cases involved the maxillary sinus, one case involved the frontal sinus, and one case involved the sphenoid sinus. There were six patients over 60 years old, and all were taking an antiplatelet agent. The paranasal sinus computed tomography (CT) of seven patients showed bony destruction of the involved sinus. A review of the available literature revealed mostly similar results with our cases, except for the proportion of patients taking aspirin (5.3%) and sex distribution (male:female = 49:25). CONCLUSIONS We reported 17 cases of OH, including a case of frontal sinus and a case of sphenoid sinus lesion. A large proportion of OH patients had bony destruction of the affected sinus on CT. In these patients, a careful diagnosis should be made to distinguish them from a malignant tumor or other expansile diseases. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Soo Jung Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Sung Tae Seo
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Ki-Sang Rha
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Yong Min Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, South Korea
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18
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Chae HD, Choi SH, Park SH, Jung HW, Yun TJ, Kim JH, Sohn CH. Organized hematoma developed after suboccipital craniectomy. J Neuroimaging 2014; 24:610-612. [PMID: 25370341 DOI: 10.1111/jon.12083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 03/03/2013] [Accepted: 03/31/2013] [Indexed: 11/26/2022] Open
Abstract
An organized hematoma shows a heterogeneous signal intensity on T1-and T2-weighted images on MR imaging, reflecting variable stages of hemorrhage. Although rather nonspecific, precontrast CT images of an organized hematoma demonstrate inhomogeneous hyperdense mass with or without calcification. We report a case of an organized hematoma in a 44-year-old man, which developed 5 years after decompressive suboccipital craniectomy following acute cerebellar infarction. To our best knowledge, there has been no report describing organized hematoma in the suboccipital craniectomy site. Computed tomography and magnetic resonance imaging findings of the organized hematoma are shown and discussed. We believe that recognition of the characteristic imaging findings of the organized hematoma as well as consideration of the history of surgery or anticoagulation treatment assists in its correct diagnosis enabling an inappropriate surgery to be avoided.
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Affiliation(s)
- Hee-Dong Chae
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital, Seoul, Korea, 28, Yongon-dong, Chongno-gu, Seoul, 110-744, Korea
| | - Seung Hong Choi
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital, Seoul, Korea, 28, Yongon-dong, Chongno-gu, Seoul, 110-744, Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Hee-Won Jung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Tae-Jin Yun
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital, Seoul, Korea, 28, Yongon-dong, Chongno-gu, Seoul, 110-744, Korea
| | - Ji-Hoon Kim
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital, Seoul, Korea, 28, Yongon-dong, Chongno-gu, Seoul, 110-744, Korea
| | - Chul-Ho Sohn
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital, Seoul, Korea, 28, Yongon-dong, Chongno-gu, Seoul, 110-744, Korea
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19
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CT and MR imaging findings of sinonasal angiomatous polyps. Eur J Radiol 2013; 83:545-51. [PMID: 24380636 DOI: 10.1016/j.ejrad.2013.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 11/28/2013] [Accepted: 12/05/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To characterize the CT and MR imaging findings of patients with sinonasal angiomatous polyps (SAPs) and evaluate their respective clinical value in the diagnosis of SAP. METHODS CT and MR imaging findings of 15 patients with pathologically proven SAP were examined. Assessed image features included location, size, margin, attenuation, and change of the bony walls of the sinonasal cavity on CT, and signal intensity and enhancement pattern on MR. RESULTS On CT, the SAP was mostly isoattenuated with patches of slight hyperattenuation. Most lesions caused changes in the adjacent bone, including expansile remodeling (n=8), defect or destruction (n=7), and hyperostosis (n=6). All lesions examined by MR showed heterogeneous isointense signal intensity on T1-weighted images and mixed obvious hyperintense and hypointense signal intensity with linear hypointense septum internally (n=10), and hypointense peripheral rim on T2-weighted images (n=10). Postcontrast MR images demonstrated areas of heterogeneous and marked enhancement with an unenhanced hypointense rim and septa (n=7). CONCLUSIONS CT and MR imaging have respective advantages in the diagnosis of SAP. Combined application of CT and MR examinations is necessary for patients with suspected SAP.
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20
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Wu AW, Ting JY, Borgie RC, Busaba NY, Sadow PM, Juliano AF, Gray ST, Holbrook EH. Diagnostic characteristics of sinonasal organizing hematomas: avoiding misdiagnosis. Int Forum Allergy Rhinol 2013; 3:598-602. [PMID: 23307434 DOI: 10.1002/alr.21147] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Revised: 11/02/2012] [Accepted: 11/29/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Organizing hematomas of the paranasal sinuses are diagnostic dilemmas clinically and radiographically, mimicking benign or malignant neoplastic processes and causing patients and clinicians undue worry regarding these diagnoses. Diagnostic criteria for correctly identifying these lesions are not well known. METHODS A retrospective case series of 7 patients with sinonasal organizing hematoma was studied. Radiographic imaging, clinical characteristics, and pathology were reviewed for new insights. RESULTS Three patients presented with a primary complaint of epistaxis, 4 had masses visible on nasal endoscopy, and 2 had vascular malformations or small hemangiomas adjacent to the mass found on final pathology. Biopsy of these masses were consistently nondiagnostic prior to complete resection. The most diagnostic findings were "shells" of T2 hypointensity on magnetic resonance imaging (MRI) surrounding the lobules of each of the masses. These correspond to rims of fibrosis at the periphery of the lobules on pathology. Areas of fresh hemorrhage are located at the center of these lobules. CONCLUSION Sinonasal organizing hematomas are rare lesions of the paranasal sinuses whose clinical characteristics lead to misdiagnoses of benign or malignant neoplasms. Endoscopy, preoperative biopsy, and computed tomography (CT) imaging do not lend helpful information in differentiating these lesions from more worrisome neoplastic processes. However, MRI can lead to positive diagnosis by recognizing the distinct outer rims of T2 hypointensity typically seen in these lesions.
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Affiliation(s)
- Arthur W Wu
- Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA
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21
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Kuo CL, Li WY, Luo CB, Ho CY. Ruptured internal carotid artery aneurysm presenting as a sinonasal organized hematoma: conventional approach may endanger life. J Neuroimaging 2012; 24:199-201. [PMID: 23253161 DOI: 10.1111/j.1552-6569.2012.00753.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Revised: 02/15/2012] [Accepted: 04/15/2012] [Indexed: 10/27/2022] Open
Abstract
Sinonasal organized hematoma (SOH) is an uncommon benign entity with locally aggressive behavior. The conventional approach is complete resection. This approach, however, can cause massive hemorrhage and mortality in our patient due to a ruptured internal carotid artery (ICA) aneurysm hidden inside the SOH. To the best of our knowledge, this is the first case of a huge SOH with skull base invasion caused by a hidden ICA aneurysm, which usually would not be large enough to result in a sinonasal mass lesion. This case suggests that the possibility of an aneurysm should always be considered if a SOH is suspected, especially when it is huge and close to the ICA. Surgical resection may not be the first therapeutic choice unless the differential cause of a hidden aneurysm can be excluded.
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Affiliation(s)
- Chin-Lung Kuo
- Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
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22
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Pixel-based time–intensity curve analysis and apparent diffusion coefficient mapping of sinonasal organized hematomas. Oral Radiol 2010. [DOI: 10.1007/s11282-010-0042-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Suzuki H, Inaba T, Hiraki N, Hashida K, Wakasugi T, Kadokawa Y, Udaka T. Endoscopic sinus surgery for the treatment of organized hematoma of the maxillary sinus. Kurume Med J 2009; 55:37-41. [PMID: 19571491 DOI: 10.2739/kurumemedj.55.37] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Organized hematoma is a benign and non-neoplastic lesion, however, differential diagnosis from neoplastic diseases is always problematic, and patients are often forced to sustain excessive surgical invasion. We retrospectively studied the characteristics of imaging findings of organized hematoma of the maxillary sinus, and estimated the validity and effectiveness of endoscopic sinus surgery for the treatment of this disease. Three patients (2 men and a woman, ranging in age from 50 to 62 years) with organized hematoma of the maxillary sinus who underwent endoscopic sinus surgery were retrospectively analyzed. The diagnosis was provisionally made based on the findings of preoperative computed tomography (CT) and magnetic resonance imaging (MRI), and was confirmed by histopathological examinations of surgical specimens. CT revealed a well-defined expansile mass in the unilateral sinus associated with thinning and expansion of the medial sinus wall in all the cases. On contrast-enhanced images, patchy heterogeneous enhancement was observed. Intermingled low/intermediate/high signal intensity was seen on both T1- and T2-weighted MRI. The lesions were curetted via an endoscopic middle meatal antrostomy with the assistance of a microdebrider. None of the patients received arterial embolization or blood transfusion. Histopathological findings were consistent with those of organized hematoma. Their postoperative courses were uneventful, and all the patients are currently free from disease. We conclude that organized hematoma of the maxillary sinus can be successfully treated by endoscopic sinus surgery under accurate preoperative diagnosis and careful surgical planning.
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Affiliation(s)
- Hideaki Suzuki
- Department of Otorhinolaryngology, School of Medicine, University of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu 807-8555, Japan.
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Organised haematoma of the sphenoid sinus mimicking a pituitary tumour. The Journal of Laryngology & Otology 2009; 124:83-5. [PMID: 19545462 DOI: 10.1017/s002221510900574x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We report an extremely rare case of an organised haematoma arising in the sphenoid sinus. CASE REPORT An 85-year-old woman presented with an expansile soft tissue mass in the left sphenoid sinus, with bony destruction of the sella turcica, which mimicked the extrasellar extension of a pituitary tumour. The tumour was excised using an endoscopic, transsphenoidal approach. Histopathological examination revealed an organised haematoma. CONCLUSION To our knowledge, this is the first report of an organised haematoma arising in the sphenoid sinus. This case indicates that organised haematoma should be included in the differential diagnosis of extensive sphenoid lesions; it also emphasises the importance of correct pre-operative diagnosis for therapeutic planning, as complete surgical resection by an endoscopic approach is curative.
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