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Clinical Problem Solving: Radiology |

Radiology Quiz Case 1

Siew Min Keh, MRCS, DO-HNS; Mingyann Lim, MRCS, DO-HNS; Ravi Lingam, MRCP, FRCR
Arch Otolaryngol Head Neck Surg. 2007;133(4):407. doi:10.1001/archotol.133.4.407.
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A 54-year-old woman with a history of recurrent left-sided lower motor neuron facial palsy presented with left-sided atypical facial pain and gradual hearing impairment. Examination of the cranial nerves showed no abnormalities. There were no cerebellar or pyramidal signs. Endoscopic examination of the left nostril revealed a medial bulging, friable mass and thinning of the posterior maxillary wall. An audiogram demonstrated bilateral mild to moderate sensorineural hearing loss with a maximum hearing loss threshold of 50 dB. Magnetic resonance imaging revealed a 2.0×1.5×2.0-cm well-circumscribed heterogeneous mass in the left pterygopalatine fossa that bowed the posterior wall of the maxillary sinus anteriorly. The signal intensity of the mass was predominantly low on T1-weighted images (Figure 1) and intermediate to low on fluid-attenuated inversion recovery images (Figure 2), but it was high on T2-weighted images (Figure 3 and Figure 4). The paranasal sinuses were clear. The patient underwent an endoscopic biopsy of the mass. An immunohistochemical stain (S100 protein) confirmed the diagnosis, and the lesion was excised.

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