Lobular capillary hemangioma of the nasal cavity

Lobular capillary hemangioma of the nasal cavity, also known as nasal pyogenic granuloma, is an uncommon benign, rapidly growing vascular neoplasm of the nasal cavity.

Terminology

The term “pyogenic granuloma” is a misnomer due to its lack of infectious origin according to histological and microbiological studies.

Clinical presentation

Epistaxis and nasal obstruction are the most common presenting symptoms, less commonly followed by rhinorrhea and extranasal symptoms e.g. facial pain and headache ²

Pathology

Lobular capillary hemangiomas are most commonly seen in the head and neck usually originating from the gingiva, lips or tongue. Nasal cavity involvement is rare.

The most common site for nasal lobular capillary hemangioma is the anterior nasal septum, followed by the turbinates and the roof of the nasal cavity ¹.

Radiographic features

CT

• nasal lobular capillary hemangioma appears as a well-circumscribed, hypoattenuating, soft-tissue mass in a characteristic location, with an average size of 1-2 cm, however, larger lesions up to 8 cm have been reported
• no calcification
• bone remodeling may be seen
• usually intense diffuse homogenous enhancement, occasionally inhomogeneous enhancement with spotty/linear foci of relative hypoenhancement or central enhancement with a hypoattenuating rim

MRI

• nasal lobular capillary hemangioma appears as homogeneously isointense soft tissue mass on T1-weighted images and heterogeneously hyperintense with a hypointense rim on T2-weighted images
• low voids and intralesional foci of hemorrhage can be seen ⁴
• post-contrast MR, lobular capillary hemangioma appears as an intensely enhancing lesion with a non-enhancing rim ⁴

Treatment and prognosis

Surgical excision is the preferred treatment for nasal lobular capillary hemangioma. Other methods may be used, for example, electrocoagulation, cryotherapy, laser therapy and (rarely) excisional surgery after endovascular embolization ¹.

Differential diagnosis

The differential diagnosis includes other nasal masses:

• inverting papilloma
• angiomatous polyp
• juvenile angiofibroma
• hemangiopericytoma
• nasal glial heterotopia
• encephalocele
• meningocele