Presentation
Incidental finding on brain MRI done for persistent headaches.
Patient Data
Small well-defined soft tissue nodule of the anterior aspect of the left nasal cavity with a broad-based attachment to the nasal surface with medial displacement of the inferior nasal concha. It elicits an intermediate signal on T1, and a very high signal on T2 fat sat with no restricted diffusion and vivid heterogeneous enhancement. The underlying nasal cartilage shows a normal appearance.
Mild peripheral mucosal thickening of the paranasal sinuses mainly of the maxillary antrum with partial opacification of the ethmoid air cells.
Normal appearance of the posterior cranial fossa and cerebral hemispheres.
Case Discussion
The MRI features and location of the lesion suggest probably a pyogenic granuloma (also known as a lobular capillary hemangioma).
Pyogenic granulomas most commonly arise secondary to a prior injury, often quite trivial, although spontaneous occurrence is also described. On imaging, it appears as a soft tissue lesion with marked contrast enhancement.
On imaging, the main differential considerations include other nasal masses such as:
angiomatous polyp
hemangiopericytoma
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