CASE 821 Published on 22.05.2001

Nasofrontal mass

Section

Head & neck imaging

Case Type

Clinical Cases

Authors

JC Le Van An, F. Rety,D. Doyon

Patient

40 years, male

Categories

No Area of Interest ; Imaging Technique Ultrasound, MR, CT, MR

No Procedure ; No Special Focus ;

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Clinical History

A 40- year-old man had a nasofrontal mass for several years.This mass become painfull, with a inflammatory aspect for few weeks.

Imaging Findings

A 40- year-old man had a nasofrontal mass for several years.This mass become painfull, with a inflammatory aspect for few weeks.Physical examination results were normal.His medical history was unremarkable, and there was no pertinent family history.Ultrasound examinations, computed tomography and MRI examinations were performed.

Discussion

The most common of congenital midline masses are dermoid/epidermoid tumors, nasal gliomas and nasal encephaloceles. They are probably due to incomplete regression of embryonic dural diverticula in the nasofrontal region. Encephalocele result from herniation of intracranial tissue into the dural projection through the foramen caecum.MR imaging shows a mass contiguous with the brain with the same signal characteristics.nasal gliomas are encephaloceles in which the connection to the brain has partially or completely sealed off. The incomplete regression of the embryonic nasofrontal diverticula with trapping of nonglial tissue result in nasal dermoid sinus and nasal dermoid/epidermoid cyst. The masses are located in the subcutaneous fat of nose.The masses are low attenuation on CT and with short T1,T2 (dermoid cyst) or long T1, T2 (epidermoid) relaxation time. In this case, the Saggital T2-weighted image of the patient show a discretly heterogenous hyperintense mass, different from brain signal, the diagnosis of encephalocele or glioma can be excluded.The most probable diagnosis is dermoid or epidermoid cyst.Nasal derlmoid cyst appear sporadically in the general population with a male predominance.The dermal sinuses could be infected and this infection is the reason for presentation.The infection is usually superficial like this case where dermal sinus are not present.Previous report, indicate that nasal dermoid cyst are frequently associated with intracranial extension. In this case, there is no connection of the lesion with intracranial structure probably because the prenasal space and the foramen cecum become obliterated until few years into postnatal life.

Differential Diagnosis List

Nasal dermoid cyst

Final Diagnosis

Nasal dermoid cyst

References

[1] Allbery, S. M., G. Chaljub, et al. (1995). “MR imaging of nasal masses.” Radiographics 15(6): 1311-27. (PMID: 8577959)

[2] Barkovich, A. J., P. Vandermarck, et al. (1991). “Congenital nasal masses: CT and MR imaging features in 16 cases.” AJNR Am J Neuroradiol 12(1): 105-16. (PMID: 1903239)

[3] Denoyelle, F., V. Ducroz, et al. (1997). “Nasal dermoid sinus cysts in children.” Laryngoscope 107(6): 795-800. (PMID: 9185736)

[4] Uglietta, J. P., O. B. Boyko, et al. (1989). “Intracerebral extension of nasal dermoid cyst: CT appearance.” J Comput Assist Tomogr 13(6): 1061-4. (PMID: 2584485)

Case information

URL:	https://www.eurorad.org/case/821
DOI:	10.1594/EURORAD/CASE.821
ISSN:	1563-4086

Figure 1

picture

Nasofrontal inflammatory mass

Figure 2

ultrasonography

Saggital ultrasound image Show echoechogenic mass with posterior reinforcement

Axial ultrasound image Show echoechogenic mass with posterior reinforcement

Figure 3

Axial image from CT scan Show a round isodense mass in the midline

Figure 4

MRI

Saggital T1-weighted image Show a small mass,well circumbscribed, hypointense compared with brain, adjacent to nasal cartilage

Saggital T2-weighted image Show a discretly heterogenous hyperintense mass

Saggital gadolinium-enhanced image Show enhancement in the border of the well circumscribed mass

Figure 5

dermoid cyst

The incomplete regression of the embryonic nasofrontal diverticula with trapping of nonglial tissue result in nasal dermoid sinus and nasal dermoid/epidermoid cyst.