Analysis Of Clinical Features Of Hemorrhagic And Necrotic Polyps Of Maxillary Sinus And/or Nasal Cavity

Objective:Hemorrhagic and necrotic polyps(infacted angiomatous polyps)of maxillary sinus and/or nasal cavity is an uncommon disease in otorhinolaryngology clinically, which has some character in clinical manifestation and imageology, but it is also easy to be confused with malignant tumors, inverting papilloma and angiofibroma. So clinical manifestation and imageology of 23 patients with hemorrhagic and necrotic polyps was collected, integrating with related domestic and foreign literatures reviewing simultaneously. We concluded clinical manifestation and imageology of the disease, especially paranasal sinuses CT-scan, so as to improve the accurateness of diagnosis.Methods:Twenty-three patients with hemorrhagic and necrotic polyps were evaluated retrospectively, who were diagnosed by operation and pathology, including 13 men and 10 women, with a mean age of 47 years (from 27 to 81). The course of the disease was from one month to three years variantly. The usual presenting symptoms were nasal obstruction and epistaxis. Among 23 cases, 21 presented nasalobstruction, 19 presented epistaxis, 17 had both of them. Some patients presented purulent rhinorrhea (12 cases), exophthalmos (3 cases), epiphora (3 cases),or facial anaesthesia and pain (2 cases).By rhinoscopy gray or bolarious neoplasm in nasal cavity could be observed (20 cases), which was easy to bleed with forceps (14 cases), covering blood scap (11 cases);sometimes there was no neoplasm but hemorrhagic and necrotic contents (2 cases);or there was nothing in nasal cavity (1 case).Otherwise, 3 cases had exophthalmos;2 cases had choanal neoplasm;and 2 cases had facial swelling. Five cases had been operated for nasal polyps before. All the 23 patients had underwent paranasal sinuses CT-scan. Nine cases of them had enhanced, and the constrast medium used was Ultravist 300mg I 100ml, then dosage was 1.5ml/kg, injection rate was 2ml/s, section sickness was 3.2mm,and pitch was 1.0. The scan ranges from anterior margin of frontal sinus to posterior margin of sphenoid sinus, and according to extent of disease the range was variable. The images all applied windows of soft tissue and bone.Results:The disease has no difference in ages and gender, and the course of disease is varible. The most common focus is in the unilateral maxillary sinus(21/23). involving homolateral nasal cavity( 18/21) and ethmoid sinuses(15/21).The usual presenting symptoms are nasal obstruction(21/23) and epistaxis(19/23),and few presents exophthalmos, weeping, facial swelling and anaesthesia, et al. On physical examination, there is gray or bolarious neoplasm in nasal cavity (20/23), which was easy to bleed with forceps (14/20), and few represents exophthalmos , facial swelling, et al. The representation of paranasal sinuses CT-scan can be induced as followings:1 > The lesions are commonly in maxillary sinus (21/23), less in nasal cavity (2/23), and the advanced locations usually involve homolateral ethmoid sinus and nasal cavity.2> A mass with heterogeneous density is usually showed (23/23). The central area of the mass has slight enhancement after enhancing, whilethe periphery represents irregular enhancement. 3^ Most lesions represent expansive enlargement in maxillary sinus (18/21)and nasal cavity (2/2). and remaining walls may show sclerosis. 4> The edge of the lesion is usually clear and smooth, and peripheral softtissue is not involved.Conclusion:The common presenting symptoms of hemorrhagic and necrotic polyps of maxillary sinus and/or nasal cavity are nasal obstruction and epistaxis. By rhinoscopy gray or bolarious neoplasm , which is vulnerable to bleed with forceps, can usually be observed. The paranasal sinuses CT-scan finding shows a mass with heterogeneous density in the unilateral maxillary sinus and/or nasal cavity, which has clear boundary and slight enhancement. The alterations of ambient bones involved oppressive absorption of the medial wall of the maxillary sinus, enlargement of the maxillary sinus and/or nasal cavity, and sclerosis of residual wall of the maxillary sinus. Well informed about clinical feature and imageology, especially the paranasal sinuses CT-scan, the accurateness of diagnosis can be improved.