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Clinical Problem Solving: Radiology |

Radiology Quiz Case 1

Federico Maria Gioacchini, MD; Francesco Mattioli, MD; Alessandra Todeschini, MD; Livio Presutti, MD
Arch Otolaryngol Head Neck Surg. 2012;138(11):1085. doi:10.1001/2013.jamaoto.356a 10.1001/2013.jamaoto.356b.
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A 38-year-old woman presented with a 1-year history of right eyelid swelling associated with ipsilateral orbital pain and frontal headache. She also complained of nausea and vomiting over the past 8 months and, subsequently, ptosis of the right eyelid. She had no rhinorrhea, nasal obstruction, or symptoms of sinusitis. The clinical evaluation was negative for nasal masses, and her medical history was unremarkable.

Computed tomography with contrast (Figure 1) was performed, after which T1-weighted (Figure 2) and T2-weighted (Figure 3 and Figure 4) magnetic resonance images were obtained. After the radiologic evaluation, the patient underwent surgery. A combined technique was chosen to completely remove the mass: endoscopic transnasal and frontal external approaches were performed. After the external incision, pathologic tissue was found emerging through the anterior wall of the right frontal sinus. The posterior wall of the sinus appeared completely dehiscent as a result of the erosion caused by the mass; however, the underlying dura was intact. The lesion occupying the frontal sinus was removed; then, an enlargement of the right frontal ostium was performed using an endoscopic transnasal approach.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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