Contributed by Christine C. Dorvault, MD, E. Leon Barnes, MD, John Sheaffer, and William Pasculle, ScD
Published on line in August 1998
A 29 year old naval serviceman stationed in Guam was transferred back to the United States due to visual disturbances. He had a three month history of nasal congestion and anosmia and a two week history of decreased vision in the right eye. On physical examination he was noted to have proptosis of the right eye and severe nasal polyposis. Following radiologic examination, the patient underwent surgery for removal of the nasal polyps and frontal craniotomy, dural resection and duraplasty due to extension of the lesion into the skull base.
CT scan and MR of the brain revealed a heterogeneous mass which filled the paranasal sinuses and nasal cavity, with erosion of the right orbital roof, posterior wall of the sphenoid sinus, posterior wall of the right frontal sinus, bilateral fovea ethmoidalis and cribriform plates. The mass extended into the right orbit, through an eroded lamina papyracea. In addition, MR of the skull base, paranasal sinuses and brain revealed an obstructed concha bullosa on the left. The findings of the CT and MR studies were interpreted as most likely representing polyposis of the paranasal sinuses and nasal cavities.