Presentation
Runny nose and the history of Wegner's granulomatosis.
Patient Data
There are large defects in the nasal septum and nasal cavities concha and ethmoidal air cells with marginal thick mucosa and fluid in remnant air cells of ethmoid sinus and thick medial wall of the maxillary sinuses with fluid and thick mucosa and antral obliteration of maxillary sinuses. Fluid in the right middle ear and mastoid air cells is also noted.
Case Discussion
One of the major causes of nasal septum and nasal cavities concha erosion is granulomatosis with polyangiitis which is small to medium size vessel vasculitis. Whenever the disease is suspected based on paranasal sinuses imaging, the lungs and kidneys must be evaluated and vice versa, and both biopsy and serology exam must be done for definitive diagnosis.
The clinical history of this case aid in suspecting the diagnosis, otherwise, there is a wide radiological DD including; chronic sinusitis, fungal sinusitis, sinonasal sarcoidosis, nasal necrosis due to cocaine, and other causes of nasal septal perforation.
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