Giant Rhinolith- An Unusual Entity: A Case Report

Rhinolith is defined as a mineralized mass resulting from calcification of an endogenous or exogenous nidus within the nasal cavity. A case of a 25 year old female with a history of unilateral nasal stuffiness and nasal bleed, which was clinically and radiologically diagnosed as rhinolith, is being reported here.

When the symptoms remain, the diagnosis may need a change: a missed foreign body

The unilateral nasal symptom should trigger a treating physician to a certain diagnosis. The differential diagnosis includes foreign body, rhinolith and tumour. The chronicity of symptom helps a lot with the diagnosis. Foreign body for example, tends to present with positive history of insertion, mainly by children or the acute symptom of local infection. In the presence of prolonged symptom, rhinolith should be suspected especially when the patient presents with pathognomonic nasal obstruction with foul smelly discharge. A referral should be made for a nasoendoscopy evaluation whenever a rhinitis-like symptoms remain after a period of medical treatment for allergy. We share a case of a missed diagnosis of a rhinolith after six years of symptoms. Keywords: nose; obstruction; rhinolith; unilateral

Rhinolith: An important cause of foul-smelling nasal discharge

Rhinoliths result from neglected nasal foreign bodies that gradually increase in size. They are usually discovered incidentally during routine ENT examination or due to the associated symptoms such as nasal obstruction or persistent foul-smelling unilateral nasal discharge. A case of a 14-year-old girl was reported with a year history of the symptom. The foul-smelling nasal discharge noted by her mother was not the main concern to them. She was referred by her primary care physician as she complained of impacted ear wax. However, rhinolith was incidentally found upon routine clinical examination in the ENT clinic and was removed uneventfully.

Recurrent rhinolithiasis: a case report with review of the literature / Rinolitiasis recurrente: reporte de caso y revisión de la literatura

Rhinolith is an uncommon nasal mass and a rare entity encountered in clinical practice. The typical symptoms of rhinolith are unilateral nasal obstruction, foul smelling purulent nasal discharge and epistaxis, crusting, swelling of nose or face, anosmia, epiphora and headache. In this report, we present a case of recurrent rhinolith manifesting as an incidental finding on dental radiographs. A 26-year old male patient with a history of long standing halitosis had an operation for rhinolith seven years previously. Rhinolith in the right nasal cavity was diagnosed on rigid endoscopic examination. Rhinolith was removed by using a rigid nasal endoscope under local anaesthesia. To our knowledge, recurrence of rhinolith has not been described previously in the literature.

El rinolito es una masa nasal poco común y una entidad rara en la práctica clínica. Los síntomas comunes del rinolito son: obstrucción nasal unilateral, secreción nasal purulenta y maloliente, epistaxis, encostramiento, inflamación de la nariz o la cara, anosmia, epífora, y dolor de cabeza. Este reporte presenta el caso de un rinolito recurrente, que se presentara como un hallazgo incidental en una radiografía dental. Un paciente varón de 26 años de edad, con una larga historia de consulta por halitosis con un dentista y un otorrinolaringólogo, fue operado a causa de un rinolito hace siete años. El rinolito en la cavidad nasal derecha, fue diagnosticado mediante un examen endoscópico rígido. El rinolito fue extirpado usando un una endoscopia nasal rígida, bajo anestesia local. Hasta donde sabemos, la recurrencia de rinolitos no ha sido descrita previamente en la literatura.

Rhinolith Arising from Fungus Ball in the Nasal Cavity

A rhinolith is a mineralized and calcareous mass that arise secondarily to the complete or partial encrustation of intranasal foreign bodies. The foreign body is usually exogenous in origin. Less commonly, endogenous foreign material can form the nidus of the rhinolith. Only one case of rhinolith originating from fungus ball that acts as the nidus has been reported in the nasal cavity. We recently experienced a case of rhinolith arising from fungus ball in the nasal cavity. A 14-year-old female suffered from left purulent and bloody rhinorrhea. An irregular, hard, and dark-brown pigmented lesion was observed in the left nasal cavity. It was removed by endoscopic surgery and pathologically revealed the rhinolith and confirmed the presence of a coexistent fungal nidus. Therefore, we present this rare case of rhinolith arising from fungus ball and discuss its disease entity.

Radiographic and imaging diagnosis of rhinolith in dental clinics: a case report / Diagnóstico radiográfico e imaginológico do rinólito na clínica odontológica: relato de caso

PURPOSE: Rhinolith is a calcification that occurs in the nasal cavity and may be discovered during routine radiographic exam. This calcification is rare, generally single, exogenous or endogenous, unilateral, and asymptomatic. It can cause nasal obstruction, fetid odour and purulent secretion. This study reported a case of rhinolith and its radiographic features. CASE DESCRIPTION: A female, 14-year-old patient had a radiopaque mass in the right nasal cavity. The primary treatment plan included oral surgery to remove a supposed impacted supernumerary tooth, which diagnosis was based on conventional radiographic exams. After an unsuccessful surgery, additional exam with computed tomography showed images compatible with a rhinolith. CONCLUSION: Computed tomographic scans are required for differential diagnosis of pathologies in the nasal cavity to provide proper treatment.

OBJETIVO: O rinólito é uma calcificação na cavidade nasal que pode ser descoberta durante o exame radiográfico odontológico de rotina. Esta massa calcificada é rara, pode exógena ou endógena, geralmente ocorre isoladamente, unilateral e assintomática. Pode causar obstrução nasal, odor fétido e secreção purulenta. Este estudo objetivou apresentar um caso de rinólito e suas características radiográficas. DESCRIÇÃO DO CASO: Uma paciente do sexo feminino, 14 anos de idade, tinha uma massa radiopaca na cavidade nasal direita. O tratamento odontológico primário incluía uma cirurgia para a remoção de um suposto dente supranumerário impactado diagnosticado após exames de radiografia convencional. Devido ao insucesso da cirurgia, foi realizado um exame por tomografia computadorizada e foi diagnosticado o rinólito. CONCLUSÃO: Exames de tomografia computadorizada adequados são necessários para o diagnóstico diferencial de patologias na cavidade nasal para proporcionar um tratamento adequado.

Obstrução nasal unilateral: relato de caso e revisão da literatura / Unilateral nasal obstruction: case report and literature review

Obstrução nasal apresenta diversas etiologias, sendo a mais freqüente a que acompanha os processos virais de vias aéreas superiores. Quando o sintoma é unilateral e persistente, deve ser sempre descartada a presença de corpo estranho, principalmente se acompanhado de secreção nasal fétida. Também pode representar um tumor intranasal ou outras alterações estruturais (ex.: desvio de septo e/ou hipertrofia de conchas nasais). Rinólitos são massas calcáreas devido à incrustação parcial ou completa de um corpo estranho intranasal. O objetivo deste trabalho é revisar o diagnóstico e o tratamento da obstrução nasal unilateral a partir do relato de um caso clínico de rinólito em paciente adulto. Conclui-se que obstrução nasal unilateral, persistente e resistente a tratamento clínico convencional, é sinônimo de rinoscopia e que esta deva ser realizada, preferencialmente, por meio de endoscopia (AU)

Nasal obstruction has several causes being the upper respiratory viral infections the most frequent one. The presence of a foreign body has to be ruled out when the symptom is persistent and unilateral, and is associated to malodorous discharge. It might also be a symptom of an intranasal tumor or other anatomic abnormalities (eg: septal deviation or turbinate hypertrophy). Rhinoliths are calcareous masses from the deposition of calcium and magnesium over a long lasting intranasal foreign body. The purpose of this paper is to review the diagnosis and treatment of unilateral nasal obstruction from a case report of an adult patient with a rhinolith. We conclude that unilateral nasal obstruction, persistent and resistant to conventional clinical treatment is synonymous of a nasal rhinoscopy and that the rhinoscopy should be performed with endoscopic guidance (AU)