1
|
Park MJ, Choi JW, Kim JH, Chung YS, Yu MS. Sinonasal Organizing Hematoma: Demographics, Diagnosis, and Treatment Outcomes of 112 patients. Laryngoscope 2024; 134:1581-1590. [PMID: 37772801 DOI: 10.1002/lary.31057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/17/2023] [Accepted: 09/06/2023] [Indexed: 09/30/2023]
Abstract
INTRODUCTION Sinonasal organizing hematoma (OH) is a rare, nonneoplastic lesion that often presents with epistaxis, a reddish mass, and destruction of the involved sinonasal structures. Due to its rarity, the demographics, diagnostic modalities, treatment strategies, and outcomes have not yet been studied in a large, long-term study. MATERIALS AND METHODS Retrospect cohort of 112 sinonasal OH patients treated between 1997 and 2020 in a tertiary, university hospital were evaluated. Demographics, systemic comorbidities, sinonasal surgery history, serum laboratory tests, radiological findings, and treatment results were collected. The present study aimed to assess the accuracy of preoperative computed tomography (CT), Gadolinum-enhanced magnetic resonance (MR), and punch biopsies in detecting sinonasal OH as the most likely diagnosis. In addition, incidental differences by age and year of diagnosis were calculated using the Poisson log-linear regression model. RESULTS The median age was 44, and 58% were male. Fewer than 20% of these cases had a chronic systemic comorbidity, bleeding tendency, or sinonasal surgery history. MR had the highest accuracy of (87%) to detect sinonasal OH as the most likely diagnosis, compared with contrast-enhanced-CT (53%), punch biopsy (49%), and non-enhanced-CT (16%) (all <0.05). Sinonasal OH incidence did not vary by age, but the yearly rate significantly increased by 1.05 times over 23 years (p < 0.05). Notably, 84% of 112 patients received surgical removal through the assistance of an endoscope, and none had substantial bleeding without preoperative embolization. CONCLUSION Sinonasal OH was observed regardless of age, sex, systemic comorbidities, bleeding tendency, prior sinonasal surgery, or trauma. Preoperative MR gives the highest accuracy for detecting this disease. Sinonasal OH may be safely managed with endoscopic-assisted surgery removal without embolization. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1581-1590, 2024.
Collapse
Affiliation(s)
- Marn Joon Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Inha University Medical Center, Inha University School of Medicine, Incheon, Korea
| | - Ji-Won Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Heui Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoo-Sam Chung
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myeong Sang Yu
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
2
|
Goyal A, Dubey D, Burdette JH, Coldren DL, Plonk DP, Lack CM, Bunch PM. Sinonasal organized hematoma: Case report and review of the literature. Radiol Case Rep 2023; 18:4569-4573. [PMID: 37886728 PMCID: PMC10597775 DOI: 10.1016/j.radcr.2023.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 10/28/2023] Open
Abstract
Sinonasal organized hematoma is a rare condition characterized by an organizing blood clot in the sinonasal cavity, which consists of blood products, fibrin, and dilated blood vessels. As a benign entity with an aggressive imaging appearance, it is important to differentiate sinonasal organized hematoma from malignancies affecting the paranasal sinuses and nasal cavities to guide appropriate management. In this report, we discuss the clinical presentation and diagnostic evaluation of an 82-year-old male with a left maxillary sinus organized hematoma and provide a comprehensive review of the relevant literature.
Collapse
Affiliation(s)
- Aakshit Goyal
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Devanshi Dubey
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Jonathan H. Burdette
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Daniel L. Coldren
- Department of Pathology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Drew P. Plonk
- Department of Otolaryngology – Head and Neck Surgery, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Christopher M. Lack
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Paul M. Bunch
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| |
Collapse
|
3
|
Sinha D, Dasegowda G, Gayatri Y, Viswamitra S. Sino Nasal Organizing Hematoma Masquerading as Sino-Nasal Neoplasm. Indian J Otolaryngol Head Neck Surg 2022; 74:4669-4672. [PMID: 36742895 PMCID: PMC9895526 DOI: 10.1007/s12070-021-02982-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/08/2021] [Indexed: 02/07/2023] Open
Abstract
Sino-nasal organized hematoma (OH) is an uncommon, benign condition of the sinuses. It mimics neoplasm in its clinical presentation as well on imaging appearance. Careful evaluation of the clinical history and imaging features is essential to avoid misdiagnosis. We present an interesting case of sino-nasal organizing hematoma in a 26-year-old male patient, masquerading as sino-nasal neoplasm.
Collapse
Affiliation(s)
- Dimpi Sinha
- Department of Radiology, Shri Sathya Sai Institute of Higher Medical Sciences, EPIP Zone, Whitefield, Bengaluru, 560066 India
| | | | - Yeduvaka Gayatri
- Department of Radiology, Shri Sathya Sai Institute of Higher Medical Sciences, EPIP Zone, Whitefield, Bengaluru, 560066 India
| | - Sanjay Viswamitra
- Department of Radiology, Shri Sathya Sai Institute of Higher Medical Sciences, EPIP Zone, Whitefield, Bengaluru, 560066 India
| |
Collapse
|
4
|
Jagadeeswaran VU, Vallur S, Shivanand JS. Management of Angiomatous Antrochoanal Polyp: Our Experience. Indian J Otolaryngol Head Neck Surg 2022; 74:1082-1087. [PMID: 36452723 PMCID: PMC9702278 DOI: 10.1007/s12070-020-02148-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/14/2020] [Indexed: 11/24/2022] Open
Abstract
Antrochoanal polyps are the most common type of choanal polyp. Angiomatous polyp is a rare subtype of Antrochoanal polyp that might be misdiagnosed as malignant lesion due to its clinical features. A retrospective observational study was conducted in a tertiary care hospital in patients who were diagnosed with Angiomatous Antrochonal polyp that underwent functional endoscopic sinus surgery from 2017 to 2020. We analyzed the clinical symptoms, radiological findings, and pathological features of all patients diagnosed with Angiomatous Antrochonal polyp. Unilateral nasal obstruction, rhinorrhea, and epistaxis were the common symptoms. Antrochoanal polyps all originated from maxillary sinus and extended to nasal cavity with or without involving the nasopharynx. Expansile mass with surrounding bony destruction are typical on computed tomography imaging but specific for Angiomatous Antrochoanal polyp. The magnetic resonance revealed high signal intensity on T1-weighted images and hypo-intense rim on T2-weighted images. Computed tomography and magnetic resonance together might give rise to more accurate diagnosis of Angiomatous Antrochoanal polyp. Incisional biopsy does help if the clinician suspects a malignant lesion. Complete removal is treatment of choice for Angiomatous Antrochoanal polyp.
Collapse
Affiliation(s)
| | - Srujan Vallur
- Department of ENT, 12 Air Force Hospital, Akash Vihar, Kunraghat, Gorakhpur 273002 India
| | | |
Collapse
|
5
|
Eissa L, Eid M, Razek AAKA. MR and CT imaging features of sino-nasal organized hematomas. Oral Radiol 2020; 37:297-304. [PMID: 32462337 DOI: 10.1007/s11282-020-00450-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 05/17/2020] [Indexed: 11/26/2022]
Abstract
AIM To describe the MR and CT imaging features of organized hematomas [OH]. METHODS A retrospective analysis of MR imaging and CT of eight patients [6 male, 2 females; age range is 6-86 years] with pathological proven OH was performed. Routine contrast MR and CT scan were done for all patients, and diffusion-weighted imaging and dynamic contrast CT were done for only five patients. Imaging analysis was done for the signal intensity, the enhancement pattern at MR imaging, the ADC value at DWI, bone remodeling at CT, and the neo-vascularization at dynamic contrast CT. RESULTS OH revealed T2 hypo-intense of the matrix in all patients with complete [n = 3] and incomplete [n = 5] marginal hypo-intensity rim. The lesions revealed a frond-like pattern of contrast enhancement of the central part of the lesion that associated with a peripheral rim of contrast enhancement. OH revealed unrestricted diffusion with high ADC value [1.7-2.5 × 10-3 cm2/s] in 5 patients. CT scan showed geographic bone remodeling and thinning of the nasal turbinates, and the sinus wall and contrast CT showed neo-vascularization with frond-like branching arteries of the central part of the lesions in five patients. CONCLUSION We conclude that MR and CT imaging findings can help in the diagnosis of OH.
Collapse
Affiliation(s)
- Lamya Eissa
- Department of Diagnostic and Interventional Radiology, Alexandria Faculty of Medicine, Alexandria, 21131, Egypt
| | - Mohamed Eid
- Department of Diagnostic and Interventional Radiology, Alexandria Faculty of Medicine, Alexandria, 21131, Egypt
| | | |
Collapse
|
6
|
A Case of Organizing Hematoma in a Maxillary Sinus After Reconstruction of a Blow-Out Fracture. J Craniofac Surg 2018; 28:1040-1041. [PMID: 28582957 DOI: 10.1097/scs.0000000000003788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A 36-year-old man presented because of nasal obstruction, rhinorrhea, and postnasal drip. The patient had undergone reconstruction of a blow-out fracture of the orbital floor 12 years before and had sinusitis that likely had resulted from implant migration into the maxillary sinus. The inflammation was successfully resolved, and the implant was removed through a minimally invasive endoscopic sinus surgery technique. On pathologic examination, an organizing hematoma was identified as the cause of the lesion. Pre- and postoperational paranasal sinus computed tomography images were taken to compare the anatomy of the sinus before and following surgery.
Collapse
|
7
|
Sinonasal organised haematoma: clinical features and successful application of modified transnasal endoscopic medial maxillectomy. The Journal of Laryngology & Otology 2017; 131:696-701. [PMID: 28597806 DOI: 10.1017/s0022215117001256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Although organised haematoma often induces bone thinning and destruction similar to malignant diseases, the aetiology of organised haematoma and the optimal treatment remain unclear. This paper presents the clinical features of individuals with organised haematoma, and describes cases in which a novel modified approach was successfully applied for resection of organised haematoma in the maxillary sinus. METHOD Pre-operative examination data were evaluated retrospectively. Modified transnasal endoscopic medial maxillectomy was employed. RESULTS Fourteen patients with organised haematoma were treated. Contrast-enhanced computed tomography showed heterogeneous enhancement in all patients. Eight patients underwent modified transnasal endoscopic medial maxillectomy, without complications such as facial numbness, tooth numbness, facial tingling, lacrimation and eye discharge. Dissection of the apertura piriformis and anterior maxillary wall was not necessary for any of these eight patients. No recurrence was observed. CONCLUSION Pre-operative examinations can be helpful in determining the likelihood of organised haematoma. Modified transnasal endoscopic medial maxillectomy appears to be a safe and effective method for organised haematoma resection.
Collapse
|
8
|
Pang W, Hu L, Wang H, Sha Y, Ma N, Wang S, Liu Q, Sun X, Wang D. Organized Hematoma: An Analysis of 84 Cases with Emphasis on Difficult Prediction and Favorable Management. Otolaryngol Head Neck Surg 2016; 154:626-33. [PMID: 26861229 DOI: 10.1177/0194599815625956] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 12/16/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To characterize features of organized hematoma (OH) that may cause considerable diagnostic difficulties. STUDY DESIGN Case series with chart review. SETTING Tertiary medical center. SUBJECTS AND METHODS Eighty-four patients with pathologically confirmed OH over a 10-year period were retrospectively reviewed for clinical features, imaging findings, pathologic characteristics, and treatment modalities. RESULTS This study included 39 males and 45 females who presented with frequent epistaxis and nasal obstruction. There were 62 (74%) patients >40 years old (mean, 50; range, 9-81). OH mainly originated in the maxillary sinus (n = 82) or nasal cavity (n = 2) unilaterally, and most were expansile masses (n = 73) that extended into nasal cavity (n = 71) or choanae (n = 17). Several lesions were locally aggressive and simulated a malignant process that involved the ethmoid sinus (n = 22), orbit (n = 11), pterygopalatine fossa (n = 16), infratemporal fossa (n = 9), cheek (n = 3), and hard palate (n = 3). Internal architecture on computed tomography (CT) scans showed OH with expansile remodeling of the maxillary wall (82.1%) and smooth bony destruction (70.2%), whereas T2-weighted magnetic resonance (MR) images showed inhomogeneity with a notable hypointense peripheral rim in all lesions. CT and MR contrast-enhanced images revealed patchy heterogeneous enhancement that could be interpreted according to histopathologic findings of hemorrhage and neovascularization. OH was successfully removed with endoscopic surgery, although 5 cases recurred. CONCLUSIONS OH can be successfully treated by endoscopic surgery. CT and MR examination provide characteristic findings for prediction and careful surgical planning.
Collapse
Affiliation(s)
- Wenhui Pang
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Li Hu
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Huan Wang
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Yan Sha
- Department of Radiology, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Na Ma
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Shuyi Wang
- Department of Pathology, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Quan Liu
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Xicai Sun
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Dehui Wang
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| |
Collapse
|
9
|
Hur J, Kim JK, Byun JS, Lee WJ. Imaging characteristics of sinonasal organized hematoma. Acta Radiol 2015; 56:955-9. [PMID: 25024439 DOI: 10.1177/0284185114542364] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 06/13/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Sinonasal organized hematoma is a rare benign disease that may be mistaken for malignancy. PURPOSE To define the imaging characteristics of sinonasal organized hematoma. MATERIAL AND METHODS We retrospectively reviewed computed tomography (CT) images of eight patients (4 male patients, 4 female patients; mean age, 40 years; range, 9-83 years) with pathologically proven sinonasal organized hematomas; magnetic resonance imaging (MRI) was performed in one patient among them. The following lesions characteristics were analyzed: size, shape, location, expansile nature, density, signal intensity, internal structure, enhancement pattern, and surrounding bony wall change. RESULTS The lesion sizes were in the range of 2-5.2 cm (mean, 3.55 cm), and the shapes were lobular, lumpy, or nodular. They were located in the nasal cavity (n = 1), maxillary sinuses (n = 2), or both nasal cavities and maxillary sinuses (n = 5). Expansile lesions with locally aggressive margins were observed in two cases. All lesions were hyperdense on precontrast CT scans; the smaller lesions showed even hyperdensity, whereas the larger lesions showed uneven density. The signal intensity was mixed on MRI, consisting of hemorrhage, fibrosis, and neovascularization. Papillary or frond-like enhancement was noted after contrast injection. All cases showed smooth erosion of the medial walls of the maxillary sinuses, and the epicenters were the secondary maxillary ostia. Two lesions showed erosion of the lateral walls of the maxillary sinuses and were expansile in nature. Non-hemorrhagic polyps accompanied the organized hematomas in three cases. CONCLUSION Although sinonasal organized hematoma can be mistaken for a malignant tumor, the following characteristic imaging findings facilitate the diagnosis of an organized hematoma: erosion of the bony sinus walls, markedly heterogeneous signal intensity, and papillary or frond-like enhancement.
Collapse
Affiliation(s)
- Joonho Hur
- Department of Radiology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jae Kyun Kim
- Department of Radiology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
- Department of Radiology, Kangwon National University College of Medicine, Chuncheon, Republic of Korea
| | - Jun Soo Byun
- Department of Radiology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Woong Jae Lee
- Department of Radiology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
10
|
Abstract
HISTORY A 15-year-old boy presented to the emergency department with intractable epistaxis. He had a prior history of epistaxis typically lasting 5-10 minutes and consisting of up to four episodes per year for several years. Otherwise, the patient had no relevant medical history, and he denied having prior trauma, surgery, bleeding diathesis, fever, chills, or vision changes. Likewise, the patient had no relevant family history. The patient's coagulation panel was unremarkable and included a prothrombin time of 15.4 seconds, an international normalized ratio of 1.2, and a partial thromboplastin time of 29.3 seconds. A thin-section unenhanced sinus computed tomography (CT) examination was performed. In addition, magnetic resonance (MR) imaging of the sinuses without and with intravenous contrast material was performed. The epistaxis was treated with nasal packing, which prevented further bleeding. Biopsy of the lesion was subsequently performed.
Collapse
Affiliation(s)
- Daniel Thomas Ginat
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637 (D.T.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (G.M.); and Massachusetts Eye and Ear Infirmary, Boston, Mass (G.M.)
| | | |
Collapse
|
11
|
Ding C, Wang Q, Guo Q, Wang Z, Lu X, Zhang J. Sinonasal Angiomatous Polyp: Evaluation With 2-Phase Helical Computed Tomography. Medicine (Baltimore) 2015. [PMID: 26200632 PMCID: PMC4602999 DOI: 10.1097/md.0000000000001196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Sinonasal angiomatous polyp (SAP) is a rare benign nontumorous lesion and previously considered lack of characteristic computed tomography (CT) findings. This study aimed to evaluate 2-phase helical CT for characterization of SAP. Twelve patients with pathologically confirmed SAP underwent 2-phase helical CT preoperatively. After injection of 80 mL contrast material at a rate of 3 mL/s, early and delayed phases were obtained with delays of 30 and 120 s, respectively. The degree and pattern of enhancement were visually analyzed. The attenuation changes were also analyzed quantitatively by measuring CT values and compared with those of the internal maxillary artery (IMA). All 12 cases showed vessel-like marked heterogeneous enhancement at both early and delayed phases. An irregular linear, nodular, and patchy enhancement pattern was found at the early phase, and enlarged and fused together, that is, progressive enhancement pattern was found at the delayed phase. There was no significant difference between the CT values of SAP and those of the IMA at the plain, arterial phase, and delayed phase (53 ± 6 Hounsfield units [HU] vs 56 ± 7 HU, 187 ± 56 HU vs 209 ± 71 HU, and 143 ± 22 HU vs 139 ± 19 HU, respectively, P = 0.361, 0.429, and 0.613, respectively). Vessel-like marked heterogeneous enhancement was a characteristic CT feature of SAP, and progressive enhancement on 2-phase helical CT could further convince the diagnosis.
Collapse
Affiliation(s)
- Changwei Ding
- From the Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, P.R. China (CD, QW, QG, JZ); Department of Nasology, Shengjing Hospital of China Medical University, Shenyang, P.R. China (ZW); and CT Clinical Science, Philips Healthcare, Shenyang, China (XL)
| | | | | | | | | | | |
Collapse
|
12
|
Choi SJ, Seo ST, Rha KS, Kim YM. Sinonasal organized hematoma: Clinical features of seventeen cases and a systematic review. Laryngoscope 2015; 125:2027-33. [PMID: 25682739 DOI: 10.1002/lary.25200] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 12/20/2014] [Accepted: 01/15/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Organized hematoma (OH) is a rare non-neoplastic disease. We studied the clinical characteristics of 17 patients with sinonasal OH and those of 75 cases in the English literature. STUDY DESIGN Retrospective review of medical records and systematic review of the literature on OH. METHODS Comprehensive review of the English-language literature on OH was performed. We screened all eligible cases based on initial features, and 75 eligible cases found in 15 publications were analyzed. We also retrospectively analyzed and compared medical records of 17 patients diagnosed with pathologically proven sinonasal OH. Data such as demographics, clinical characteristics, pathologic features, radiologic findings, treatment modalities, and follow-up results were compared to the 75 previously mentioned cases. RESULTS Fifteen cases involved the maxillary sinus, one case involved the frontal sinus, and one case involved the sphenoid sinus. There were six patients over 60 years old, and all were taking an antiplatelet agent. The paranasal sinus computed tomography (CT) of seven patients showed bony destruction of the involved sinus. A review of the available literature revealed mostly similar results with our cases, except for the proportion of patients taking aspirin (5.3%) and sex distribution (male:female = 49:25). CONCLUSIONS We reported 17 cases of OH, including a case of frontal sinus and a case of sphenoid sinus lesion. A large proportion of OH patients had bony destruction of the affected sinus on CT. In these patients, a careful diagnosis should be made to distinguish them from a malignant tumor or other expansile diseases. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- Soo Jung Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Sung Tae Seo
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Ki-Sang Rha
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Yong Min Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, South Korea
| |
Collapse
|
13
|
CT and MR imaging findings of sinonasal angiomatous polyps. Eur J Radiol 2013; 83:545-51. [PMID: 24380636 DOI: 10.1016/j.ejrad.2013.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 11/28/2013] [Accepted: 12/05/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To characterize the CT and MR imaging findings of patients with sinonasal angiomatous polyps (SAPs) and evaluate their respective clinical value in the diagnosis of SAP. METHODS CT and MR imaging findings of 15 patients with pathologically proven SAP were examined. Assessed image features included location, size, margin, attenuation, and change of the bony walls of the sinonasal cavity on CT, and signal intensity and enhancement pattern on MR. RESULTS On CT, the SAP was mostly isoattenuated with patches of slight hyperattenuation. Most lesions caused changes in the adjacent bone, including expansile remodeling (n=8), defect or destruction (n=7), and hyperostosis (n=6). All lesions examined by MR showed heterogeneous isointense signal intensity on T1-weighted images and mixed obvious hyperintense and hypointense signal intensity with linear hypointense septum internally (n=10), and hypointense peripheral rim on T2-weighted images (n=10). Postcontrast MR images demonstrated areas of heterogeneous and marked enhancement with an unenhanced hypointense rim and septa (n=7). CONCLUSIONS CT and MR imaging have respective advantages in the diagnosis of SAP. Combined application of CT and MR examinations is necessary for patients with suspected SAP.
Collapse
|
14
|
Organised haematoma of the maxillary sinus: pathophysiological differences suggesting a new aetiological hypothesis. The Journal of Laryngology & Otology 2013; 127:519-24. [PMID: 23552378 DOI: 10.1017/s0022215113000625] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES Organised haematomas of the maxillary sinus are rare, non-neoplastic, haemorrhagic lesions which can extend into the nasal cavity and/or the other paranasal sinuses. This study aimed to investigate the pathology of maxillary sinus organised haematoma, and also proposes a new aetiological hypothesis based on the observed pathology. METHODS Biopsies, computed tomography, magnetic resonance imaging and post-surgical histopathological examination of resected specimens were carried out. CONCLUSION Distinct pathological differences were observed between the basal and peripheral portions of organised haematomas. We propose that an organised haematoma originates from the exudation of blood components between vascular endothelial cells. As a result, the basal portion consists of aggregated, dilated vessels around the natural ostium of the maxillary sinus. In addition, pseudovessels, without endothelial cells, arise from endocapillary vessels within the haematoma. Exudation of additional blood components from the pseudovessels advances the growth of the organised haematoma.
Collapse
|
15
|
Wu AW, Ting JY, Borgie RC, Busaba NY, Sadow PM, Juliano AF, Gray ST, Holbrook EH. Diagnostic characteristics of sinonasal organizing hematomas: avoiding misdiagnosis. Int Forum Allergy Rhinol 2013; 3:598-602. [PMID: 23307434 DOI: 10.1002/alr.21147] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Revised: 11/02/2012] [Accepted: 11/29/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Organizing hematomas of the paranasal sinuses are diagnostic dilemmas clinically and radiographically, mimicking benign or malignant neoplastic processes and causing patients and clinicians undue worry regarding these diagnoses. Diagnostic criteria for correctly identifying these lesions are not well known. METHODS A retrospective case series of 7 patients with sinonasal organizing hematoma was studied. Radiographic imaging, clinical characteristics, and pathology were reviewed for new insights. RESULTS Three patients presented with a primary complaint of epistaxis, 4 had masses visible on nasal endoscopy, and 2 had vascular malformations or small hemangiomas adjacent to the mass found on final pathology. Biopsy of these masses were consistently nondiagnostic prior to complete resection. The most diagnostic findings were "shells" of T2 hypointensity on magnetic resonance imaging (MRI) surrounding the lobules of each of the masses. These correspond to rims of fibrosis at the periphery of the lobules on pathology. Areas of fresh hemorrhage are located at the center of these lobules. CONCLUSION Sinonasal organizing hematomas are rare lesions of the paranasal sinuses whose clinical characteristics lead to misdiagnoses of benign or malignant neoplasms. Endoscopy, preoperative biopsy, and computed tomography (CT) imaging do not lend helpful information in differentiating these lesions from more worrisome neoplastic processes. However, MRI can lead to positive diagnosis by recognizing the distinct outer rims of T2 hypointensity typically seen in these lesions.
Collapse
Affiliation(s)
- Arthur W Wu
- Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Organized hematoma in the paranasal sinus and nasal cavity--imaging diagnosis and pathological findings. Auris Nasus Larynx 2009; 37:173-7. [PMID: 19699045 DOI: 10.1016/j.anl.2009.06.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Revised: 05/19/2009] [Accepted: 06/21/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The "organized hematoma" is a non-neoplastic, hemorrhagic lesion, which can develop in the paranasal sinus and nasal cavity. This is the first report on the relationship between the imaging and pathological findings. METHODS We diagnosed organized hematoma, based on three criteria: no existence of neoplastic cells; consistency of hematoma and fibrosis; and development from the paranasal sinus and nasal cavity. We retrospectively investigated six cases from the patients' medical records. RESULTS On the imaging findings, the central part of the lesion was enhanced more strongly than the lesion periphery. All of the pathological findings were hematoma at the center, and fibrosis at the periphery. In three of the cases, dilated vessels were found but not in the other three. CONCLUSION We found that the biphasic appearance of the imaging findings correlated with that of the pathological findings. There are two pathological types--the dilated vessel type and the non-dilated vessel type.
Collapse
|
17
|
Suzuki H, Inaba T, Hiraki N, Hashida K, Wakasugi T, Kadokawa Y, Udaka T. Endoscopic sinus surgery for the treatment of organized hematoma of the maxillary sinus. Kurume Med J 2009; 55:37-41. [PMID: 19571491 DOI: 10.2739/kurumemedj.55.37] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Organized hematoma is a benign and non-neoplastic lesion, however, differential diagnosis from neoplastic diseases is always problematic, and patients are often forced to sustain excessive surgical invasion. We retrospectively studied the characteristics of imaging findings of organized hematoma of the maxillary sinus, and estimated the validity and effectiveness of endoscopic sinus surgery for the treatment of this disease. Three patients (2 men and a woman, ranging in age from 50 to 62 years) with organized hematoma of the maxillary sinus who underwent endoscopic sinus surgery were retrospectively analyzed. The diagnosis was provisionally made based on the findings of preoperative computed tomography (CT) and magnetic resonance imaging (MRI), and was confirmed by histopathological examinations of surgical specimens. CT revealed a well-defined expansile mass in the unilateral sinus associated with thinning and expansion of the medial sinus wall in all the cases. On contrast-enhanced images, patchy heterogeneous enhancement was observed. Intermingled low/intermediate/high signal intensity was seen on both T1- and T2-weighted MRI. The lesions were curetted via an endoscopic middle meatal antrostomy with the assistance of a microdebrider. None of the patients received arterial embolization or blood transfusion. Histopathological findings were consistent with those of organized hematoma. Their postoperative courses were uneventful, and all the patients are currently free from disease. We conclude that organized hematoma of the maxillary sinus can be successfully treated by endoscopic sinus surgery under accurate preoperative diagnosis and careful surgical planning.
Collapse
Affiliation(s)
- Hideaki Suzuki
- Department of Otorhinolaryngology, School of Medicine, University of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu 807-8555, Japan.
| | | | | | | | | | | | | |
Collapse
|
18
|
Organised haematoma of the sphenoid sinus mimicking a pituitary tumour. The Journal of Laryngology & Otology 2009; 124:83-5. [PMID: 19545462 DOI: 10.1017/s002221510900574x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We report an extremely rare case of an organised haematoma arising in the sphenoid sinus. CASE REPORT An 85-year-old woman presented with an expansile soft tissue mass in the left sphenoid sinus, with bony destruction of the sella turcica, which mimicked the extrasellar extension of a pituitary tumour. The tumour was excised using an endoscopic, transsphenoidal approach. Histopathological examination revealed an organised haematoma. CONCLUSION To our knowledge, this is the first report of an organised haematoma arising in the sphenoid sinus. This case indicates that organised haematoma should be included in the differential diagnosis of extensive sphenoid lesions; it also emphasises the importance of correct pre-operative diagnosis for therapeutic planning, as complete surgical resection by an endoscopic approach is curative.
Collapse
|
19
|
Kim EY, Kim HJ, Chung SK, Dhong HJ, Kim HY, Yim YJ, Kim ST, Jeon P, Ko YH. Sinonasal organized hematoma: CT and MR imaging findings. AJNR Am J Neuroradiol 2008; 29:1204-8. [PMID: 18403558 DOI: 10.3174/ajnr.a1042] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND PURPOSE Sinonasal organized hematoma (OH) is an uncommon, nonneoplastic benign condition that can be locally aggressive. The purpose of this work was to characterize the CT and MR imaging findings of sinonasal OH. MATERIALS AND METHODS CT (n = 11) and MR (n = 10) images of 12 patients (9 men and 3 women; mean age, 41 years; range, 12-76 years) with pathologically proved sinonasal OH were retrospectively reviewed. Particular attention was put on the location, shape, size, extent, internal architecture, and enhancement pattern of the lesion and associated sinus wall change. RESULTS The lesions were seen as an expansile (n = 9) or nonexpansile (n = 3) mass, ranging in size from 2.2 to 6.0 cm (mean, 4.2 cm), primarily involving the maxillary sinus (n = 11) or nasal cavity (n = 1) unilaterally. The ipsilateral nasal cavity was also involved in 9 of 11 maxillary sinus lesions. Smooth sinus wall erosion other than the medial maxillary sinus wall was noted in 8 lesions. The internal architecture was best displayed on T2-weighted MR images on which all of the lesions were seen as a mixture of marked heterogeneous hypointensity and isointensity, surrounded by a hypointense peripheral rim, reflecting histologic heterogeneity of the lesion composed of hemorrhage, fibrosis, and neovascularization. Marked irregular nodular, papillary, or frondlike enhancement at the areas of neovascularization was also a typical finding seen in all of the lesions. CONCLUSION An expansile soft tissue mass, smooth sinus wall erosion, marked heterogeneous signal intensity with a hypointense peripheral rim on T2-weighted MR images, and marked irregular nodular, papillary, or frondlike enhancement are characteristic CT and MR imaging findings of sinonasal OH.
Collapse
Affiliation(s)
- E Y Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Bibliography. Current world literature. Nose and paranasal sinuses. Curr Opin Otolaryngol Head Neck Surg 2007; 15:48-55. [PMID: 17211184 DOI: 10.1097/moo.0b013e32802e6d9b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
21
|
Song HM, Jang YJ, Chung YS, Lee BJ. Organizing hematoma of the maxillary sinus. Otolaryngol Head Neck Surg 2007; 136:616-20. [PMID: 17418261 DOI: 10.1016/j.otohns.2006.10.033] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2006] [Accepted: 10/20/2006] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The study aims to elucidate the clinical features and surgical results of OHMS (organizing hematoma of the maxillary sinus). STUDY DESIGN AND SETTING We performed a chart review of 20 patients undergoing surgery for maxillary sinus lesions and pathologically diagnosed with OHMS between January 1990 and December 2005. RESULTS The most common complaint was frequent epistaxis (70%). Paranasal CT scans showed unilateral expansile maxillary opacification, heterogeneous enhancement, bony destruction (25%), and focal calcification (15%). Treatment consisted of a sublabial approach combined with endonasal endoscopic surgery (50%), endonasal endoscopic surgery alone (45%), and Denker's operation (5%). All patients had a successful outcome without recurrence. CONCLUSION Conservative surgical approaches such as sublabial or endonasal endoscopic surgery alone or in combination lead to excellent outcomes without recurrence. We propose the term "OHMS" to better describe this rare pathology. SIGNIFICANCE Our report is the largest series of OHMS to date.
Collapse
Affiliation(s)
- Hyung Min Song
- Department of Otolaryngology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | | | | | | |
Collapse
|