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Sinonasal Lymphoma Presenting With Epistaxis and Nasal Obstruction
A 15-year-old boy with painless epistaxis and nasal obstruction is found to have sinonasal lymphoma.
Imaging overview:
Axial T2-weighted MRI shows a solid mass centered in the right maxillary sinus with low T2 signal. The mass is centered in the maxillary sinus rather than at the sphenopalatine foramen. The ADC map shows very low diffusion within the mass. Post-contrast fat-suppressed T1 shows enhancement of the mass that is less than that of the adjacent turbinates.
Clinical insight:
Lymphoma is an important consideration for a solid sinonasal mass in a child. The features favoring lymphoma are low T2 signal, very low ADC values from restricted diffusion, and enhancement less than the turbinates. Juvenile nasopharyngeal angiofibroma is the key differential in an adolescent boy with epistaxis and nasal obstruction. Its origin at the sphenopalatine foramen helps separate it from this mass. Rhabdomyosarcoma also belongs on the differential in children. Biopsy with immunohistochemistry is required for a definitive diagnosis.
Case courtesy of Ashley Ikegami and Rick Wiggins, MD, University of Utah.