Vegetable or Pulse Granuloma in the Nasal Cavity

Vegetable granuloma or pulse granuloma results from the implantation of food particles of vegetable origin. Pulse granulomas have mainly been reported in association with lung aspirations, the oral cavity with a history of oral procedures and less frequently in gastrointestinal tracks. We report a 31-year-old woman who presented with right nasal obstruction and was found to have a firm mass in the right nasal cavity. Paranasal sinus computerized tomography scans identified a calcified ring lesion in her right nasal cavity. Endoscopic sinus surgery was performed, and pathology examination revealed a lesion consistent with a pulse granuloma that contains starch granules with cellulose envelopes appearing as hyaline rings surrounded by inflammation cells and concentrically arranged delicate connective tissue. Pulse granuloma is a well described entity with distinct histopathology. However, pulse granulomas are rare, and especially extraoral pulse granulomas are extremely rare. We found that pulse granuloma can be occurred in the nasal cavity through regurgitation.

CT Findings of the Angiomatous Polyp in the Nasal Cavity and Paranasal Sinus

PURPOSE: To assess the characteristic CT findings of the angiomatous polyp. MATERIALS AND METHODS: Fivecases of pathologically-proven angiomatous polyp were retrospectively evaluated. All underwent CT scanning, butin only four cases were postcontrast CT scans obtained. In analysing CT findings we focused on adjacent bonychange, and the extent and enhancement pattern of the mass. RESULTS: All but one case involved the maxillarysinus, showing thickening of the posterolateral wall and erosion or destruction of the medial wall. As forinvolvement of the anterior wall of this sinus, bony destruction was seen in one case, and thickening in three. Infour cases the tumor involved the maxillary sinus and nasal cavity, and two cases showed nasopharyngeal extension.No case involved the pterygopalatine fossa, however. On contrast enhanced CT scans(n=4), all cases showedenhancement as strong as blood vessels, and a multiple focal punctate or tubular pattern. CONCLUSION: Angiomatouspolyp tends to show bone thickening rather than bone destruction, not to involve the pterygopalatine fossa, and toreveal a strong punctate or tubular enhancement pattern. These findings may be helpful in the differentialdiagnosis of angiomatous polyp from other tumors such as maxillary cancer, angiofibroma and nasal polyp

Inverted Papilloma: CT and MR Imaging Findings in Correlation with Histologic Findings

PURPOSE:To evaluate CT and MR findings suggestive of inverted papilloma by correlation with pathologic findings. MATERIALS AND METHODS: The CT(n=16) and MR(n=8) findings of 22 pathologically proven cases of inverted papilloma in the sinonasal cavity were retrospectively reviewed with reference to location of tumor, density/signal intensity, contrast enhanced appearance, shape and cleft air shadow at the free margin of tumors, and mass effect. These findings and pathologic findings were then correlated. RESULTS: All 22 tumors were located in the unilateral nasal cavity and extended into the maxillary sinus(n=17), choana(n=10), ethmoid sinus(n=8), nasopharynx(n=7), nasal vestibule(n=5) or frontal sinus(n=1). All CT scans showed that the density of tumor masses was similar to adjacent muscle. Precontrast CT scans showed no visibles triations' within the tumor mass, but postcontrast scans revealed striations' of varying degree in six of nine cases. CT scans showed that the free margin of tumors was serrated(n=13) or lobulated(n=5), and in 13 cases cleft air shadow of varying shape was noted. All MR scans showed's triations' with intermediate/slightly high signal intensity on T1WI and intermediate/high on T2WI within tumor masses, which were more prominent on postcontrast scans. On MR, the free margin of tumors was seen to be serrated(n=5), lobulated(n=4), or smooth(n=1), but cleft air shadow was not detected. CONCLUSION: The triations' seen on postcontrast CT and MR images and the cleft air shadow with a serrated appearance seen on CT images at the free margin of tumors suggested the presence of inverted papilloma in the sinonasal cavity.

CT and MR evaluation of Choanal Polyps

PURPOSE: To evaluate the various types and CT and MR imaging findings of choanal polyps. MATERIALS AND METHODS: We classified 42 cases of surgically proven choanal polyps into three types according to site of origin,and retrospectively analyzed imaging findings; in the case of antrochoanal polyps, particulr attention was givento extension of the lesion into the nasal cavity. We also determined whether MR imaging can provide moreinformation than CT. RESULTS: The antrochoanal polyp was the most common type( 33/42 : 78.6% ). Three cases ofchoanal polyps(7.1%) originated in the sphenoid sinus (sphenochoanal polyps), and while six( 14.3% ) did notinvolve the sinus( pure choanal polyps ). Thirty-six of 42 choanal polyps(85.7%) extended into either the choanaor nasopharynx. Three cases of antrochoanal polyps protruded through the middle meatus, and two into theoropharynx. The maxillary sinus component of an antrochoanal polyps extended more frequently through the accessoryostium( 29/33 ) than through the natural ostium. For delineating the stalk of an antrochoanal polyp, MR imagingwas not superior to CT. CONCLUSION: The most common type of choanal polyp is the antrochoanal, followed by purechoanal and sphenochoanal. CT and MR imaging can help identify lesion continuity between a choanal polyp and theparanasal sinus.

CT and MR Findings of the Inverted Papilloma

PURPOSE: The purpose of this study is to describe the CT and MR findings of inverted papilloma and to determine the specific differential finding between inverted papilloma with and without coexisting malignancy. MATERIALS AND METHODS: Twenty-two histopathologically proven inverted papillomas were included in this study; in six patients there was coexisting malignancy. Twenty-two CT images and eight MR images were retrospectively reviewed. RESULTS: On CT images, the inverted papillomas were seen as unilateral sinonasal masses with bone remodeling (n=15) rather than bone destruction (n=1) and showed iso- or slightly high attenvation. Three of the six malignant cases showed aggressive bone destruction and widespread extension into the orbit, intracranial and buccal spaces, and pterygopalatine fossa. On MR images, the inverted papillomas (n=3) were iso- (n=2) or slightly high (n=1) in signal intensity in relation to muscle on T1 weighted images, and high (n=3) on T2 weigihted images. Gadolinium enhanced images showed heterogenous moderate enhancement. In the cases of coexisting malignancy (n=5), the masses were iso- (n=5) on T1 weighted images, high (n=5) on T2 weighted images and also showed heterogenous moderate enhancement. CONCLUSION: Inverted papilloma should be considered in the differential diagnosis of a bulky unilateral nasal mass extending into the adjacent paranasal sinuses, especially in an elderly patient with chronic nasal obstruction. Although there were no specific differential findings in signal intensiy and enhancement pattern on CT and MR images between benign and malignant inverted papilloma, aggressive bone destruction and widespread extension beyond the sinonasal cavity are findings which are highly suggestive of coexisting malignancy.

CT Findings of Inverted Papilloma and Aspergiollosis in Sinonasal Cavities: CT differentiation

PURPOSE: To describe the characteristic CT findings of inverted papilloma (IP) and aspergillosis involving sinonasal cavities and to differentiate between them on CT. MATERIALS AND METHODS: We retrospectively reviewed CT images in 22 cases of pathologically confirmed IP and 16 of aspergillosis; these were classified as one of four types, according to location. We also analyzed infundibular widening, displacement of the maxillary medial wall, the presence of air in the maxillary ostium, elevation of ethmoidom axillary plate (EMP), calcification within a lesion, reactive hyperostosis and CT density. RESULTS: Four cases were type I, which was seen only in aspergillosis (4/16, 25%); five were type IV, and all were IP (5/22, 22.7%), with a characteristic growing vector. Type II was seen in nine cases of IP and 11 of aspergillosis, and type III in eight cases of IP and one of aspergillosis. In types II and III (17 of 22 cases of IP; 12 of 16 of aspergillosis), five of 22 cases of IP (22.7%) and nine of 16 of aspergillosis (56.3%) showed infundibular widening, which was more severe in aspergillosis. Maxillary medial wall displacement was seen in five of 22 cases (22.7%) of IP, four of which showed lateral displacement and in five of 16 cases (31.3%) of aspergillosis, all of which showed medial displacement. Air in the maxillary ostium was seen in seven of 22 cases of IP (31.8%). Elevation of EMP was seen in two cases of IP (9.1%) and three of aspergillosis (18.8%), which showed oblique elevation. Calcification was detected in nine cases of aspergillosis (56.3%) but in only one of IP. Reactive hyperostosis was seen in 13 cases of aspergillosis (81.3%) and two of IP (9.1%). CONCLUSION: Although it is hard to differentiate between IP and aspergillosis involving sinonasal cavities, the findings of calcification, infundibular widening, air in the maxillary ostium,displacement of the maxillary medial wall, an elevated EMP pattern and reactive hyperostosis combined with duration of symptom may be helpful.