Presentation
Small vascular nodule of the left nasal cavity on ENT exam in pregnant patient at 25 weeks gestation with a history of recurrent epistaxis.
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 septum. It shows an intermediate signal on T1, and a very high signal on T2 and T2 fat sat. The underlying nasal cartilage shows a normal appearance.
The postcontrast T1 sequences were not performed (pregnant patients).
Mild peripheral mucosal thickening of the maxillary, sphenoid and frontal sinuses with partial opacification of the ethmoid air cells.
Case Discussion
The clinical presentation, the ENT exam and 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. They demonstrate more rapid growth in the presence of female hormones, which is thought to explain their commonality in pregnancy as in this case. 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:
- juvenile angiofibroma
- angiomatous polyp
- inverting papilloma
- hemangiopericytoma