An extremely rare and atypical paediatric presentation of a
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Haemangiomas are benign, vascular neoplasms which can arise from most tissue cells in the human body. They very rarely arise from the paranasal sinuses. Vascular tumours/malformations are uncommon findings in the nasal cavity, and if are found, are very unlikely to be haemangiomas.

This otherwise fit and well, 16-year-old girl was referred to the paediatric ear, nose and throat (ENT) team by her general practitioner because of ongoing right nasal obstruction, with associated suspected recurrent right-sided sinusitis. She complained of right frontal headaches with fullness, postnasal drip, mucous and discharge from the right nostril which was often foul smelling, hyposmia and intermittent right-sided epistaxis. These symptoms had been persisting for just under 1 year prior to being seen in the ENT clinic. This has been managed by her general practitioner with multiple courses of antibiotics and a nasal spray, with no improvement in her symptoms.

On initial assessment in clinic, she had left nasal rhinitis and the right nasal vestibule was full of mucous and yellow discharge. She was started on chronic rhinosinusitis treatments including nasal douching, antibiotics and a steroid-based nasal spray. A non-contrast CT scan of the sinuses was requested as opposed to an MRI modality as a mass lesion was not visualised or suspected. At her next review, the symptoms other than nasal obstruction and blockage, had slightly improved. Flexible nasoendoscopy revealed a large polyp arising from the right maxillary sinus and occupying a significant proportion of the nasal cavity. She still had ongoing evidence of rhinitis. The scan revealed a polypoidal mass extending from the right maxillary sinus, occupying most of the right nasal cavity, suspected to be an antrochoanal polyp.

Source: BMJ case reports

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