Sphenoid sinus organized hematoma with cranial neuropathies masquerading as a malignancy: A case report

Stroke a rare manifestation of isolated sphenoid sinus aspergilloma: a case report

Isolated sphenoid sinus disease is a rare paranasal sinus (PNS) problem, comprising only 2-3% of cases of sinonasal diseases. It is caused mainly by inflammation, and neoplastic causes are exceedingly rare. Due to the nonspecific nature of the symptoms and possible complications, the proper diagnosis and treatment has paramount importance. A 53-year-old woman with a history of diabetes experienced sudden paralysis of the right side of her body and face. A diagnostic workup revealed an acute infarction in her left medial pons and the left midbrain. However, an abnormal finding in her sphenoid sinus caught the neurologist's attention, which led to a consultation with the otorhinolaryngology service. During the sinonasal endoscopy, the surgeon detected the presence of secretions and fungal debris in the nasopharynx and sphenoid sinus. Following the surgery, antifungal treatment began. The pathology report revealed that the fungal ball was most likely caused by aspergillosis. According to the neurologist's opinion and the imaging results, the inflammation and infectious activity in the patient's sphenoid sinus may have damaged the basilar artery and caused the observed symptoms. This finding underlines the vital significance of the accurate diagnosis and treatment of sphenoid sinus disease, as it can prevent further complications.

Organized hematoma of the sphenoid sinus with epistaxis

Few reports have been made on organized hematoma (OH) originating in the sphenoid sinus. We report the case of a 24-year-old man who presented to the hospital with consistent epistaxis for 1 month. Preoperative computed tomography and magnetic resonance imaging (MRI) detected an expansive heterogeneous mass with minimal bone destruction and hypointense peripheral rim in T2-weighted images of the left sphenoid sinus as a solitary lesion. An OH was suspected first based on the history of repeated epistaxis and characteristic imaging findings, although quite rare. Preoperative vascular embolism was not performed because its effects on the ocular artery should be considered. With endoscopic sinus surgery under hypotensive anesthesia, the mass was carefully and successfully removed without bleeding and diagnosed as OH based on postoperative pathological examination. When solitary lesions are found in the sphenoid sinus with epistaxis, this disease should be differentiated. If it increases, complications, such as visual impairment, frequently occur, and control of intraoperative bleeding is sometimes difficult. Not only missing the characteristic imaging findings, especially MRI with contrast administration but also evaluating the anatomical relationship between OH and other important organs is important for a successful intervention of sphenoid sinus OH.

Successful Endoscopic Transsphenoidal Approach Treatment of Sphenoid Sinus Organized Hematoma Causing Visual Deficit: A Case Report

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.

Sinonasal Organised Haematoma- A Case Report and Review of Literature

Sinonasal organised haematoma (SOH) is an uncommon, benign condition that can be locally aggressive. SOH can be mistaken for a malignant tumour but the characteristic imaging findings and histopathology facilitate the diagnosis of an organised haematoma. We report a 26 year old male patient presenting with unilateral nasal obstruction and painless epistaxis, which are the most common presenting symptoms of sinonasal tumour lesions. Based on the clinical features, age, radiological investigation, intraoperative finding, location of the lesion and histopathological examination; a diagnosis of SOH was arrived at. Surgical excision utilized the COBLATION technology and endoscopic complete removal of the nasal mass was done. Intraoperatively minimal bleeding was encountered. On histopathology, haematoma at the center and fibrosis at the periphery was noted. To our knowledge, this is the first reported case of SOH excision using Coblator. No recurrence was seen in subsequent follow ups. Although SOH can be mistaken for a malignant tumour, the characteristic imaging and histopathology findings facilitate the diagnosis of an organised haematoma.

Organised hematoma mimicking sino-nasal malignancy in patients post-radiotherapy

INTRODUCTION

Organised hematoma (OH) in the para-nasal sinus and nasal cavity is a rare, non-neoplastic, benign disease which can be locally aggressive. In clinical practice, OH is easily misdiagnosed as malignancy and over-treated.

CASE SUMMARY

These patients with OH had a common history of malignant neoplasms post-radiotherapy, including two cases of nasopharyngeal carcinoma and one case of tonsil cancer with jaw osteosarcoma. All of the patients presented with symptoms of epistaxis and blood-tinged rhinorrhea. All of the patients received endoscopic endonasal surgery under navigation.

DISCUSSION

All of the patients had a good recovery after surgery. There's no recurrence after follow-up at 6 months. We therefore hypothesised that radiotherapy could be a cause of the OH. Although OH is uncommon and difficult to diagnose, a history of malignancy and imaging features with appropriate treatment are key.

Organized Hematoma of the Sphenoid Sinus With Acute Blindness: Insight Into Pathogenesis of Disease

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.

MR and CT imaging features of sino-nasal organized hematomas

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.

Organized hematoma of the sphenoid sinus causing acute visual loss

Sinonasal organized hematoma, which has locally aggressive characteristics, is a non-neoplastic disease. We report a rare case of sphenoid sinus organized hematoma causing acute visual loss. A 35-year-old male presented with progressive headaches, retro-orbital pain, and frequent epistaxis. He had a medical history of aplastic anemia and of taking warfarin for a valvular heart disease. On image studies, an expansive soft tissue density lesion with bony destruction was found in his left sphenoid sinus. While waiting for elective surgery, acute visual loss occurred. Emergent endoscopic surgery was performed after correction of abnormal hematological profiles, but his visual disturbance did not improve. Although sphenoid sinus organized hematoma is a rare disease, organized hematoma should be considered in the differential diagnosis for sphenoid sinus lesion with acute visual loss. Rapid and correct diagnosis and timely treatment are essential to prevent permanent sequela.