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Organizing Hematoma of the Maxillary Sinus Mimicking Malignancy Diagnosed by Fluorodeoxyglucose Positron-Emission Tomography (FDG PET/CT): A Case Report.

Park YK, Kim KS - Iran J Radiol (2015)

Bottom Line: The clinical, radiological, and histopathologic findings of the patient are presented.In this report, we have presented (18)FDG-PET findings of organized hematoma of the maxillary sinus (OHMS) that showed an increased FDG uptake in the peripheral rim of the mass with central photopenia.Careful interpretation of metabolic (FDG-PET/CT) and anatomic (CT and MRI) images should be performed to accurately characterize the expansile lesion of the maxillary sinus in order to increase specificity and reduce equivocal findings significantly.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea.

ABSTRACT
Organizing hematoma of the paranasal sinuses is a diagnostic dilemma clinically and radiographically, mimicking benign or malignant neoplastic processes. Although the diagnostic rate of this disease has increased as characteristic imaging findings are somewhat elucidated, endoscopic examination, preoperative biopsy, and computed tomography (CT) imaging do not give helpful information in differentiating these lesions from malignant neoplastic processes. A 55-year-old man presented with a 4-month history of recurrent nasal bleeding. He also complained of a left-sided nasal obstruction. CT findings were highly suggestive of a malignant tumor of the maxillary sinus. However, based on fluorodeoxyglucose F(18) positron-emission tomography (PET/CT) and magnetic resonance imaging (MRI), the provisional diagnosis of benign tumor rather than malignancy was made. Complete resection of the mass was achieved by simple transnasal endoscopic surgery using the Caldwell-Luc approach. Organizing hematoma of the maxillary sinus was diagnosed by histopathologic evaluation. The clinical, radiological, and histopathologic findings of the patient are presented. In this report, we have presented (18)FDG-PET findings of organized hematoma of the maxillary sinus (OHMS) that showed an increased FDG uptake in the peripheral rim of the mass with central photopenia. To our knowledge, this is the first case report in the literature reporting FDG-PET/CT findings of OHMS. Careful interpretation of metabolic (FDG-PET/CT) and anatomic (CT and MRI) images should be performed to accurately characterize the expansile lesion of the maxillary sinus in order to increase specificity and reduce equivocal findings significantly.

No MeSH data available.


Related in: MedlinePlus

Enhanced CT of the paranasal sinuses shows a 4.3 × 2.8 × 4.3 sized heterogeneous enhanced soft tissue mass in the maxillary sinus, the central region of which was in particular strongly enhanced (arrow head). The expansion of the maxillary sinus and bony thinning of the posterior and medial wall of the left maxillary sinus are also noted (black arrows). A, nonenhanced axial section. B and C, enhanced axial sections. D, enhanced coronal section. Also, CT scans showed the opacification of the sphenoid and ethmoid sinuses because of the mass obstructing the draining sinus ostia (asterisk).
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fig21772: Enhanced CT of the paranasal sinuses shows a 4.3 × 2.8 × 4.3 sized heterogeneous enhanced soft tissue mass in the maxillary sinus, the central region of which was in particular strongly enhanced (arrow head). The expansion of the maxillary sinus and bony thinning of the posterior and medial wall of the left maxillary sinus are also noted (black arrows). A, nonenhanced axial section. B and C, enhanced axial sections. D, enhanced coronal section. Also, CT scans showed the opacification of the sphenoid and ethmoid sinuses because of the mass obstructing the draining sinus ostia (asterisk).

Mentions: A 55-year-old man presented with a 4-month history of recurrent nasal bleeding. He also complained of a left-sided nasal obstruction. He had no history of antecedent trauma, nasal surgery, or bleeding diatheses and no facial numbness or pressure. His medical and family histories were noncontributory. On physical examination, no facial deformity and eye movement limitation was detected. His complete hematology profile and coagulation tests were normal. On endoscopic examination, the left lateral nasal wall was medially displaced towards the nasal septum, blocking the nasal passage completely. So, it was not possible to examine the nasal cavity endoscopically because of the narrowed passage. After shrinkage of the inferior turbinate mucosa, we observed a lobulated pinkish mass in the inferior meatus that caused medial displacement of the inferior turbinate (Figure 1). Preoperative biopsy was performed from the mass of the inferior meatus, but the results demonstrated only vascular fibrous tissue with chronic inflammation. Enhanced CT of the paranasal sinuses showed a 4.3 × 2.8 × 4.3 cm sized heterogeneous enhanced soft tissue mass in the maxillary sinus, the central region of which was in particular strongly enhanced (Figure 2). The expansion of the maxillary sinus and bony thinning of the posterior and medial wall of the left maxillary sinus were also noted. The mass caused obstruction of the left nasal cavity with medial displacement of the middle and inferior turbinate. CT findings were highly suspicious for a malignant tumor of the maxillary sinus. He simultaneously underwent MRI and whole-body combined 18F-PET/CT for evaluation of a malignant tumor of the maxillary sinus. T1-weighted MRI images revealed a large, lobulated mass that was mostly isodense to the inferior turbinate diffusely interspersed with hyperintensity. T2-weighted images showed the marked heterogeneity of the lesion with a mix of hypointense (peripheral part), isointense, and hyperintense (central part) signals and a dark peripheral rim surrounding the lesion. Bright signal intensity due to mucosal inflammation of the involved maxillary sinus was distinguished from the lesion on T2-weighted images (Figure 3).


Organizing Hematoma of the Maxillary Sinus Mimicking Malignancy Diagnosed by Fluorodeoxyglucose Positron-Emission Tomography (FDG PET/CT): A Case Report.

Park YK, Kim KS - Iran J Radiol (2015)

Enhanced CT of the paranasal sinuses shows a 4.3 × 2.8 × 4.3 sized heterogeneous enhanced soft tissue mass in the maxillary sinus, the central region of which was in particular strongly enhanced (arrow head). The expansion of the maxillary sinus and bony thinning of the posterior and medial wall of the left maxillary sinus are also noted (black arrows). A, nonenhanced axial section. B and C, enhanced axial sections. D, enhanced coronal section. Also, CT scans showed the opacification of the sphenoid and ethmoid sinuses because of the mass obstructing the draining sinus ostia (asterisk).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4644966&req=5

fig21772: Enhanced CT of the paranasal sinuses shows a 4.3 × 2.8 × 4.3 sized heterogeneous enhanced soft tissue mass in the maxillary sinus, the central region of which was in particular strongly enhanced (arrow head). The expansion of the maxillary sinus and bony thinning of the posterior and medial wall of the left maxillary sinus are also noted (black arrows). A, nonenhanced axial section. B and C, enhanced axial sections. D, enhanced coronal section. Also, CT scans showed the opacification of the sphenoid and ethmoid sinuses because of the mass obstructing the draining sinus ostia (asterisk).
Mentions: A 55-year-old man presented with a 4-month history of recurrent nasal bleeding. He also complained of a left-sided nasal obstruction. He had no history of antecedent trauma, nasal surgery, or bleeding diatheses and no facial numbness or pressure. His medical and family histories were noncontributory. On physical examination, no facial deformity and eye movement limitation was detected. His complete hematology profile and coagulation tests were normal. On endoscopic examination, the left lateral nasal wall was medially displaced towards the nasal septum, blocking the nasal passage completely. So, it was not possible to examine the nasal cavity endoscopically because of the narrowed passage. After shrinkage of the inferior turbinate mucosa, we observed a lobulated pinkish mass in the inferior meatus that caused medial displacement of the inferior turbinate (Figure 1). Preoperative biopsy was performed from the mass of the inferior meatus, but the results demonstrated only vascular fibrous tissue with chronic inflammation. Enhanced CT of the paranasal sinuses showed a 4.3 × 2.8 × 4.3 cm sized heterogeneous enhanced soft tissue mass in the maxillary sinus, the central region of which was in particular strongly enhanced (Figure 2). The expansion of the maxillary sinus and bony thinning of the posterior and medial wall of the left maxillary sinus were also noted. The mass caused obstruction of the left nasal cavity with medial displacement of the middle and inferior turbinate. CT findings were highly suspicious for a malignant tumor of the maxillary sinus. He simultaneously underwent MRI and whole-body combined 18F-PET/CT for evaluation of a malignant tumor of the maxillary sinus. T1-weighted MRI images revealed a large, lobulated mass that was mostly isodense to the inferior turbinate diffusely interspersed with hyperintensity. T2-weighted images showed the marked heterogeneity of the lesion with a mix of hypointense (peripheral part), isointense, and hyperintense (central part) signals and a dark peripheral rim surrounding the lesion. Bright signal intensity due to mucosal inflammation of the involved maxillary sinus was distinguished from the lesion on T2-weighted images (Figure 3).

Bottom Line: The clinical, radiological, and histopathologic findings of the patient are presented.In this report, we have presented (18)FDG-PET findings of organized hematoma of the maxillary sinus (OHMS) that showed an increased FDG uptake in the peripheral rim of the mass with central photopenia.Careful interpretation of metabolic (FDG-PET/CT) and anatomic (CT and MRI) images should be performed to accurately characterize the expansile lesion of the maxillary sinus in order to increase specificity and reduce equivocal findings significantly.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea.

ABSTRACT
Organizing hematoma of the paranasal sinuses is a diagnostic dilemma clinically and radiographically, mimicking benign or malignant neoplastic processes. Although the diagnostic rate of this disease has increased as characteristic imaging findings are somewhat elucidated, endoscopic examination, preoperative biopsy, and computed tomography (CT) imaging do not give helpful information in differentiating these lesions from malignant neoplastic processes. A 55-year-old man presented with a 4-month history of recurrent nasal bleeding. He also complained of a left-sided nasal obstruction. CT findings were highly suggestive of a malignant tumor of the maxillary sinus. However, based on fluorodeoxyglucose F(18) positron-emission tomography (PET/CT) and magnetic resonance imaging (MRI), the provisional diagnosis of benign tumor rather than malignancy was made. Complete resection of the mass was achieved by simple transnasal endoscopic surgery using the Caldwell-Luc approach. Organizing hematoma of the maxillary sinus was diagnosed by histopathologic evaluation. The clinical, radiological, and histopathologic findings of the patient are presented. In this report, we have presented (18)FDG-PET findings of organized hematoma of the maxillary sinus (OHMS) that showed an increased FDG uptake in the peripheral rim of the mass with central photopenia. To our knowledge, this is the first case report in the literature reporting FDG-PET/CT findings of OHMS. Careful interpretation of metabolic (FDG-PET/CT) and anatomic (CT and MRI) images should be performed to accurately characterize the expansile lesion of the maxillary sinus in order to increase specificity and reduce equivocal findings significantly.

No MeSH data available.


Related in: MedlinePlus