CASE 12410 Published on 09.03.2015
0

An unusual cause of nasal obstruction: rhinolithiasis

Section

Head & neck imaging

Case Type

Clinical Cases

Authors

Ammor H1, Boujarnija H2, Lamrani H2, Boubbou M2, Maaroufi M2, Tizniti S2

(1) Service de Radiologie,
Hôpital Moulay El Hassan Ben El.
Mehdi. Laayoune
(2) Service de Radiologie,
CHU Hassan II,
Fes, Morocco;
Email:ammor_hicham@hotmail.com
Connected authors
hicham ammor Morocco
Patient

22 years, male

Categories
Area of Interest Head and neck ; Imaging Technique CT
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Clinical History
A 22-year-old male patient came with complaints of left-sided nasal block for 3 years associated with epistaxis.
Anterior rhinoscopy found a dirty white irregular hard mass occupying the left nasal cavity. The mass was gritty on probing. The probe could be passed all around the mass.
Imaging Findings
Axial and coronal CT showed a homogeneous, high-density irregular mass occupying the left nasal cavity. The central portion of the lesion was of somewhat lower density.
Discussion
Rhinolithiasis is the constitution of rhinoliths inside the nasal cavity as a result of the accumulation of calcium phosphate and magnesium around a central nucleus [1].
Their formation is produced by in situ calcification of intranasal endogenous or exogenous foreign material [2].
The first reported case of rhinolithiasis was made by Barthdin in 1654 [1].
The most common location of rhinoliths is in the middle of the lower nasal duct and most of the cases are unilateral [1].
Even though their pathogenesis remains unclear, some factors are thought to be involved in their production [3]. These include entry and impaction of a foreign body into the nasal cavity, obstruction and stagnation of nasal secretions, acute and chronic inflammation and precipitation of mineral salts [4].
Most of the patients present with purulent rhinorrhea and/or ipsilateral nasal obstruction. Other symptoms include fetor, epistaxis, sinusitis, headache and, rarely, epiphora. In some patients, rhinoliths are found incidentally [3].
Rhinoscopy often finds a mass or nodule with well- or ill-defined borders and a hard gritty sensation on piercing [5].
In 1900, MacIntype presented the first radiological description of rhinolith [6]. The typical radiological appearance is a radio-opacity with central transparency [7]. CT examination of the paranasal sinuses can correctly determine the location and size of the rhinolith and diagnose any coexisting sinus disease which may need treatment [8].
CT shows a homogeneous, high-density lesion with smooth mineralization [7]. The central portion of the lesion, that may contain organic material, may be of somewhat lower density [7]. Endoscopic examination is the principal step in diagnosis which can be supported by medical imaging [3].
The choice of surgical approach relies on the site and size of the rhinolith and the eventual presence of complications, but most may be removed endonasally [3].
Recurrence after the removal of the rhinolith has not been reported in the literature so far [9].
Differential Diagnosis List
Rhinolith
Osteoma
Calcified polyp
Final Diagnosis
Rhinolith
Case information
URL: https://www.eurorad.org/case/12410
DOI: 10.1594/EURORAD/CASE.12410
ISSN: 1563-4086
Figure 1

Facial CT

Facial CT
Axial and coronal CT shows a homogeneous, high-density irregular mass occupying the left nasal cavity. The central portion of the lesion is of somewhat lower density.
Facial CT
Axial and coronal CT shows a homogeneous, high-density irregular mass occupying the left nasal cavity. The central portion of the lesion is of somewhat lower density.
Facial CT
Axial and coronal CT shows a homogeneous, high-density irregular mass occupying the left nasal cavity. The central portion of the lesion is of somewhat lower density.
Facial CT
Axial and coronal CT shows a homogeneous, high-density irregular mass occupying the left nasal cavity. The central portion of the lesion is of somewhat lower density.