13 year old boy with feeling fullness of face

 

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Doctor's Information

Name : Morteza
Family : Sanei Taheri
Affiliation :Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree : Associate Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Razmin Aslani

 

Case Section

Head & Neck Imaging

 

Patient's Information

Gender : Male
Age : 13

 

Clinical Summary

A 13 year old boy with respiratory complain and feeling of fullness in face.

 

Imaging Findings

Paranasal sinus CT scan without contrast shows mucosal thickening and increased secration in paranasal sinuses & defect in nasal septum.

 

Differential Diagnosis

Inflammatory:Fungal infection/Mucormycosis/Aspergillosis/syphilis/tuberculosis Granulomatous disease:Wegener's granulomatosis/Midline destructive granuloma Neoplastic: Benign:Inverting papilloma/Juvenile angiohbroma Malignant:Squamous cell carcinoma/Adenoid cyst/Adenocarcinoma/Lymphoma/Metastasis trauma:surgical/repeated cauterydigital trauma (nose picking) poisons:industrial/cocaine related injury/topical corticosteroids/topical decongestants idiopathic

 

Final Diagnosis

biopsy proved Wegener's granulomatosis

 

Discussion (Related Text)

Wegener's granulomatosis is fundamentally a necrotizing granulomatous vasculitis that initially involves the respiratory tract and eventually spreads to include the kidneys as well as other organs. When the sinonasal cavity is involved, the nasal septum is affected initially with diffuse thickening followed by septal perforation.(1) Non-specific mucosal thickening or antral opacificationare typical early features, followed by nasal septal including a necrosed nasal septum (saddle nose deformity), though the sinuses may atrophy and the maxillary bone progressively ossifythinning and granulomatous ulcerated change. Bony destruction is also frequently demonstrated on CT

 

References

1-John R.Haaga , CT and MRI of the whole body , fifth edition 2009 , page 576 2-Imaging of Wegener’s granulomatosis.S D ALLEN, MB BS, MRCS, FRCR and C J HARVEY, MB BS, MRCP, FRCR.Department of Imaging, Imaging Sciences Department, Hammersmith Hospital, Imperial College Faculty of Medicine, Du Cane Road, London W12 ONN, UK

 

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