CT and MR imaging findings of sinonasal angiomatous polyps

doi:10.1016/j.ejrad.2013.12.002

European Journal of Radiology

Volume 83, Issue 3, March 2014, Pages 545-551

https://doi.org/10.1016/j.ejrad.2013.12.002 Get rights and content

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.

Introduction

Sinonasal angiomatous polyp (SAP) is a rare benign and non-neoplastic lesion. It is primarily composed of extensively hyperplastic and dilated vessels with scanty inflammatory infiltration and abundant extracellular fibrin [1], [2]. Although inflammatory sinonasal polyp (SNP) is the most common non-neoplastic sinonasal mass examined pathologically, as a special subtype SAP only accounts for 4–5% of all SNPs [1].

Simple conservative surgical excision of SAP is curative, and postoperative recurrence is rare. Therefore, correct preoperative diagnosis of SAP is important lest patients undergo unnecessary extensive surgery [3]. SAP may show similar imaging features with sinonasal masses, such as other SNP, inverted papilloma, fungus ball, capillary hemangioma, juvenile angiofibroma and some possibly malignant tumors [2], [4], [5]. To the best of our knowledge, there have been only a few studies describing the imaging features of SAP [1], [2], [3], [4], [5], [6], [7], [8]. The purpose of this study was to report the characteristic CT and MR imaging findings of SAP in the sinonasal cavity.

Section snippets

Patients

The present study was approved by the institutional review board. Between July 2008 and February 2013, a total of 15 patients with pathologically proven SAP were retrospectively reviewed. The patients included five men and 10 women, age range from 12 to 81 years, with a mean age of 42.7 years. CT (n = 13) and MR (n = 10) images of these 15 patients were retrospectively reviewed.

Among these 15 cases, two patients had a history of craniofacial trauma 2 days and 2 years previously, respectively.

Results

The symptoms of the patients were nasal obstruction in 80.0% (12/15), epistaxis in 53.3% (8/15), rhinorrhea (n = 4), headache (n = 3), facial numbness (n = 2), visual acuity reduction (n = 1), hyposmia (n = 3), and syrigmus (n = 2).

Histopathological examinations showed most of the central areas of the lesion were composed of hemorrhage with extensive hyperplastic and dilated thin-walled blood vessels, fibrosis, and thrombus formation, and areas of focal inflammation. The central areas were surrounded by

Discussion

There are numerous descriptions of SAP in the literature, including organized or organizing hematoma [3], [7], [8], [9], [10], [11], [12], [13], [14], cavernous hemangioma [15], [16], [17], hemangioma [18], [19], hematoma-like mass of the antrum [20], pseudotumor [21], hemorrhage necrotic polyp, and angioectatic or angiomatous polyp [1], [2], [4], [5], [6], [22], [23]. Study and comparison of these seven terms shows that they all share the same clinical, pathological, and imaging features. The

Conclusions

Correct preoperative diagnosis is important for determining therapeutic schedules, because SAP is usually curative with complete surgical resection by endoscopic sinus surgery. CT and MR imaging have respective advantages in the diagnosis of SAP. Preoperative CT images that show the changes in adjacent bones can provide an accurate basis for the determination of the surgical scope. Preoperative MR images that show the characteristic appearance in signal intensity can provide an accurate

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Radiologists inexperienced in head and neck pathology may misdiagnose ACC in the maxillary sinus as sinonasal angiomatous polyps. The main features of sinonasal angiomatous polyps are as follows: They (1) mostly affect young adults, (2) are mostly isoattenuated with patches of slight hyperattenuation on CT images, (3) exhibit heterogeneous isointense signal on T1WI and a hypointense peripheral rim on T2WI, and (4) show nodular or patchy enhancement after Gd-DTPA (gadolinium–diethylenetriamine penta-acetic acid) administration.28 The present study has a few limitations, including heterogeneity and a small sample size.
The aim of this study was to investigate computed tomography (CT) and magnetic resonance imaging (MRI) findings in adenoid cystic carcinoma (ACC) in the maxillary sinus and their correlations with the tubular, cribriform, and solid histopathologic types of ACC.
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On CT, significant differences were discovered among the 3 histopathologic ACC types in range, size, shape, margins, type of bone destruction, and time intensity curve (TIC) (P ≤ .018). Tubular lesions were limited in range, were smaller than the other types, produced small cystic patterns with well-defined margins, and caused a cribriform pattern of bone destruction. All tumors demonstrated heterogeneous intensity signal on T1- and T2-weighted images (T1WI and T2WI) and appeared as hypo- or isointense small cystic lesions on T1WI and hyperintense on T2WI (n = 6). Postcontrast MRI revealed marked heterogeneous enhancement for all lesions. The TIC showed a rapidly enhancing and slow washout pattern in all tubular lesions and a rapidly enhancing and rapid washout pattern in solid tumors.
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Citation Excerpt :
It is primarily composed of extensively hyperplastic and dilated vessels with scanty inflammatory infiltration and abundant extracellular fibrin.1 The most common presentations are nasal obstruction and epistaxis.2 A 29-year-old lady presented with progressively worsening unilateral right nasal blockage for 6 months duration which was associated with occasionally foul smelling discharge from the similar side.
Epistaxis is a common complaint seen in the younger population. Its etiology is typically from the anterior nares, although we present a case of epistaxis from an uncommon source. Diagnosis of bleeding nasal mass is varied from benign to malignant lesions. Angiomatous antrochoanal polyps (AAP) are one of the causes but it is rare and the diagnosis is challenging as it mimic other nasal mass especially nasopharyngeal angiofibroma (NA). There are a lot of similarities of clinical presentations, between imaging and histopathological findings between these two which made the diagnosis even more difficult. A correct diagnosis is extremely important as although they have similar clinical presentations, the management is different. Here we report a case of a young lady with significant epistaxis which was initially diagnosed as NA but with a final revised diagnosis of AAP.
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¹: Both of them contributed equally and both of them are first author.

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CT and MR imaging findings of sinonasal angiomatous polyps

Abstract

Objective

Methods

Results

Conclusions

Introduction

Section snippets

Patients

Results

Discussion

Conclusions

Auris, Nasus, Larynx

Otolaryngology – Head and Neck Surgery: Official Journal of American Academy of Otolaryngology – Head and Neck Surgery

Angiectatic nasal polyps that clinically simulate a malignant process: report of 2 cases and review of the literature

Archives of Pathology & Laboratory Medicine

Infarcted angiomatous nasal polyps

European Archives of Otorhinolaryngology

Sinonasal organized hematoma: CT and MR imaging findings

AJNR American Journal of Neuroradiology

MR evaluation of sinonasal angiomatous polyp

AJNR American Journal of Neuroradiology

Correlation of computed tomography with pathological features in angiomatous nasal polyps

PLOS ONE

Sinochoanal polyp and its variant, the angiomatous polyp: MRI findings

European Radiology

Organized hematoma of the maxillary sinus: CT findings

AJR American Journal of Roentgenology

Expansile organized maxillary sinus hematoma: MR and CT findings and review of literature

AJNR American Journal of Neuroradiology

Organized hematoma of maxillary sinus mimicking malignant neoplasm in a patient following chemoradiotherapy

Journal of Otolaryngology – Head & Neck Surgery

Endoscopic sinus surgery for the treatment of organized hematoma of the maxillary sinus

Kurume Medical Journal

Radiology quiz case 2. Organized hematoma of the maxillary sinus

Archives of Otolaryngology – Head & Neck Surgery