Nasal obstruction in a 14 year old girl caused by a huge middle turbinate mucocele appearing radiologically as an inverted papilloma

Authors

  • William Wakeford ENT Specialty Registrar, ENT Department, Colchester Hospital, East and North Essex NHS Foundation Trust, Colchester, UK https://orcid.org/0000-0002-2973-8119
  • Dimitrios Ioannidis Consultant ENT Surgeon, ENT Department, Colchester Hospital, East and North Essex NHS Foundation Trust, Colchester, UK

DOI:

https://doi.org/10.3941/jrcr.v17i9.4774

Keywords:

Concha Bullosa Mucocele, Concha Bullosa, Middle Turbinate, Paediatric Nasal Mass

Abstract

Introduction: We present a case of a fourteen year old girl who presented with a large intra-nasal mass to the ENT team at a district general hospital in the UK.

Presentation of case: The girl presented predominantly with nasal obstruction and some symptoms of allergic rhinitis. Imaging revealed a large lesion abutting the skull base and causing bony remodelling with marked septal deviation. Based both on CT and MRI imaging, the reporting (non-head and neck) radiologist suggested inverted papilloma as a differential diagnosis. Intra-operative exploration in fact revealed a very large left middle turbinate mucocele extending to the left frontal sinus. The mass was excised endoscopically without complications.

Discussion: Although concha bullosa of the middle turbinate of the nose are common, development of a mucocele within them is far less common and for such a mucocele to develop to this size in a child is extremely rare. The egg shell lining of the lesion can be a tell-tale sign of their aetiology when taken alongside other radiological factors. This case highlights challenges in radiological diagnosis of intra-nasal masses in children, which can lead to delays and increased anxiety.

Conclusion: When assessing nasal masses in children it is important to keep a wide differential due to the challenges of diagnosis. A close conversation should be had with local head and neck radiologists and, of course, where there is a unilateral nasal mass tissue sampling is essential and may be taken as part of a full excision where clinically indicated.

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Published

2023-09-30

Issue

Section

General Radiology