Diagnostic dilemma - sinonasal organizing hematoma

Abstract

Sinonasal organizing hematomas are benign lesions often mistaken for malignancy due to their aggressive appearance on diagnostic imaging and endoscopic findings that favor advanced disease. The destructive nature of this pathology paired with the rarity of the presentation often results in diagnostic deception that may escalate intervention planning and affect discussion of prognosis with patients. Herein, we present a case of a 56-year-old male with left-sided nasal obstruction and daily epistaxis, where computed tomography imaging revealed heterogeneous opacification of the left maxillary sinus, erosion of the left inferior orbital wall and extension into the nasal cavity. Although clinical and radiographic presentations of sinonasal organizing hematomas can be managed definitively with endoscopic intervention, there is a need to increase awareness of this entity among clinicians to improve our prognostic counseling with patients.

Keywords: Sinonasal hematoma; Sinonasal organizing hematoma; benign neoplasm; organized hematoma; paranasal sinuses; sinonasal malignancy.

Figure 1.

(a) Non-contrast CT of the sinuses revealed a mass with heterogeneous density in the left maxillary sinus, smooth bony destruction of the left medial and lateral maxillary sinus walls, extension into the nasal cavity, and erosion of the left inferior orbital wall. Arrows demonstrate regions of bony destruction with the lesion crossing the midline septum and eroding through the floor of the maxillary sinus and involving the alveolus and (b) magnetic resonance imaging with gadolinium revealed a heterogeneously enhancing mass with foci of high T1 and low T2 signals suggesting blood products.