Antrochoanal polyp

Case contributed by Dr Azza Elgendy

Presentation

Opacified left maxillary sinus

Patient Data

Age: 63 year old
Gender: Female
Modality: MRI

There is total opacification of the left maxillary antrum extending through a widened , smoothly remodeled  osteomeatal unit to fill the whole ipsilateral nasal cavity. It is protruded through the ipsilateral choana to fill the nasopharyngeal air way . It is abutting the soft palate and  extending into the right choana to reach the right nasal cavity. The polypoidal soft tissue is homogenous (fluid signals) T2 hyperintense and T1 hypointense. Following GAD there is only smooth peripheral enhancement with no soft tissue enahancement.The remainder ipsilateral sinuses are opacified by retentional phenomenon  There is no restricted diffusion. There is small retension cyst in the right maxillary sinus . The imaging finding are most consistent with  a large left antrochoanal polyp. 

Case Discussion

Imaging features

Polypoid mass arises from the maxilary antrum then extend through the osteomeatal unit to fill the nasal cavity give the classic "dumbbell-shaped lesion" with maxillary antral origin connected by narrow stalk from maxillary infundiubulum / accessory ostium protruding to the nasal cavity. Larger lesions protrudes through the choana to fill the nasopharyngeal airway. 

CT: Dumbbell-shaped, low mucoid density mass originates from the maxillary antrum, extends through widened maxillary ostium or accessory ostium into ipsilateral nasal cavity. There is no bone destruction but remodeled  surrounding infundibulum/accessory ostium .

MRI: Homogeneous fluid signals T2 hyperintense, T1 hypointense (the signals may be variable with chronicity). Only shows peripheral mucosal enhancement. No central enhancement.

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Case Information

rID: 27474
Case created: 3rd Feb 2014
Last edited: 23rd Jan 2017
System: Head & Neck
Tag: polyp
Inclusion in quiz mode: Included

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