CONTINUING MEDICAL EDUCATION

 

Image and diagnosis

 

 

EW Williams; H Ashman; R Edwards

Department of Surgery, Radiology, Anaesthesia and Intensive Care, The University of the West Indies, Kingston 7, Jamaica, West Indies

Correspondence

 

 

Clinical Data

A 26-year-old female presented to the Emergency Department of the University Hospital of the West Indies with a sudden prolapse of a fleshy material from her right nostril after sneezing. She had no airway problems and besides recurrent attacks of sinusitis, she has been in excellent health.

Examination findings confirm a friable haemorrhagic mass occupying the right nostril Figs 1a and 1b. The rest of the ear, nose and throat examination was normal.

 

 

 

 

What is the diagnosis?

 

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Answer to image and diagnosis

 

 

Diagnosis

Prolapsed Nasal Polyp

Comment

Nasal polyps are not true neoplasms. They are fluid-filled sacs composed of oedematous stroma infiltrated by chronic inflammatory cells and eosinophils and lined by respiratory or squamous epithelium.

Simple nasal polyps are usually bilateral, pale and insensitive. Nasal polyps that prolapse through the nostrils often appear vascular because of venous congestion. These polyps are associated with bronchial asthma, aspirin hypersensitivity and cystic fibrosis. The differential diagnosis in adults includes neoplasms such as inverted papilloma, sinonasal carcinoma and olfactory neuroblastoma. Neoplasms are usually unilateral, friable, and firm and bleed spontaneously. Nasal polyps are rare in children except for antrochoanal polyps which prolapse from the maxillary sinus into the nasopharynx. In children, meningocoele, meningomyelocoele or encephalocoele may project through the cribriform plate into the nose. Computed Tomography scan should be used for evaluation of the paranasal sinuses in all cases. Unilateral polyps should be biopsied. The mainstay of medical therapy is oral and nasal steroids. Endoscopic sinus surgery and polypectomy is the definite therapy, as was in this case.

 

 

Correspondence:
Dr EW Williams
Emergency Medicine Division, Department of Surgery, Radiology, Anaesthesia and Intensive Care
The University of the West Indies, Kingston 7, Jamaica, West Indies
Fax (876) 927-2101, e-mail: verz3us@yahoo.com.