Open Journal of Medical Imaging, 2012, 2, 10-18
http://dx.doi.org/10.4236/ojmi.2012.21002 Published Online March 2012 (http://www.SciRP.org/journal/ojmi)
Nasal Cavity Masses: Clinico-Radiologic Collaborations,
Differential Diagnosis by Special Clues
Duzgun Yildirim1, Omer Saglam2, Berk Gurpinar2, Turan Ilica3
1Department of Radiology, Iskenderun Military Hospital, Hatay, Turkey
2Department of Head and Neck Surgery, Kasimpasa Military Hospital, Istanbul, Turkey
3Department of Radiology, Gulhane Military Medical Academy, Ankara, Turkey
Received November 18, 2011; revised December 30, 2011; accepted January 13, 2012
ABSTRACT
Purpose: Nasal cavity may contain wide variety of masses within, that differs this organ from the rest of the body.
Primary nasal cavity masses consist of 0.2% - 0.8% of all malignancies. This paper aims to emphasize the main
characteristics of different nasal cavity masses on cross-sectional images which may cause symptoms varying from
simple nasal obstruction to metastatic invasion. We tried to solve the diagnostic bias by focusing on the special clues
with the aid of the striking images caused by the same appearence of nasal cavity masses on cross-sectional
radiologic images. Materials and Method: 66 retrospective dataset of patients (male: 35, female: 31, mean age: 43
years) were reviewed by the cross-sectional images. All cases had nasal passage obstruction and all cases had
previously undergone maxillofacial imaging (computerized tomography, CT (n = 43); magnetic resonance imaging,
MRI (n = 21); positron emmision tomography, PET/CT (n = 2)). Results: Totally, 48 benign and 18 malignant cases
which have distinct pathologies were reviewed. All the lesions occupying space through the nasal cavity were
demonstrated on cross-sectional images. With the typical cross-sectional images, an algoritm was made to help the
differential diagnosis and presented as a scheme to presume the most feasible diagnosis. Conclusion: Sinunasal
masses may have the worst prognosis on late diagnosis because of the probability of early invasion of the basicranial
structures or cranial nerves. Verification of the neoplasm by the specific cross-sectional images, either benign or
malignant, could be done at once.
Keywords: Nasal Cavity; Neoplasms; Imaging; Differential Diagnosis
1. Introduction
Nasal cavity contains different kinds of tissues such as
the epithelial (squamous, neuroendocrine, olfactory) and
the mesenchimal (bone, cartilage, muscle, vascular) ones
and all of these may carry the risk for a variety of tumoral
differentiation. Despite the wide range of diversity, the
incidence of the nasal tumors are as low as 1/100.000 [1].
Primary nasal malignancies consist of 0.2% - 0.8% of all
the malignant tumors and 3.6% of the malignant upper
airway tumors [1].
CT (computerized tomography) and MRI (magnetic
resonance imaging) were useful in evaluating various
kind of the nasal cavity masses. They may differentiate
the contents, contrast enhancement patterns of the lesions
and localize the tumor, thus these cross-sectional imaging
modalities are being used frequently to differentiate the
nasal cavity masses [1]. Additionally, PET/CT, which is
consisted by fusion of both the PET (positron emission
tomography) and CT systems, has the advantage of pro-
viding functional assessment additional to lesion deter-
mination [1].
In this study our primary goal was to mention the
common features of the benign and malignant nasal tumors
that usually give symptoms such as nasal congestion,
blockage, rhinorrheae, headache, proptosis, trismus, cra-
nial neuropathy; whereas the radiologic examination of
the cross-sectional images of various types of nasal
tumors that mostly block the airway. We also briefly
stated the main clinic and surgical approaches to those
cases and gave a brief discussion of the literature.
2. Materials and Methods
66 cases (male: 35, female: 31, mean age: 43 years) com-
plaining of nasal obstruction and those previously un-
derwent maxillofacial imaging with at least one of the
following cross-sectional imaging modalities (computerized
tomography, CT (n = 43); magnetic resonance imaging,
MRI (n = 21); positron emmision tomography, PET/CT
(n = 2)) between January 2005 and May 2010 were re-
cruited.
C
opyright © 2012 SciRes. OJMI

D. YILDIRIM ET AL. 11
Standard Protocol That Was Applied to All
Cases Investigated for Nasal Cavity Masses
In two cases, examinations had been performed with
PET/CT device (Discovery ST PET/16 slice CT fusion
system HPOWER 60; General Electric Medical Systems,
Milwaukee, WI), after intravenous administration of 13 -
15 mCi FDG (Fludeoxyglucose) 40 - 60 minutes before
the procedure. A section thickness of 3.75 mm was ad-
justed for PET images and MPR, MIP and fused images
were simultaneously evaluated on multi-display worksta-
tions. For fused CT, a section thickness of 3.75 cm, pitch
1.75, colimation 10 mm, kV 120, and mAs 100 - 120
were preferred.
MR imaging had been performed on a 1.5-T scanner
(The New Intera Nova Philips Medical Systems, Best,
The Netherlands) with variable TR and TE values. Mul-
tiplanar, turbo spin-echo and gradient echo mixed images
and coronal T2-weighted images were obtained. The sec-
tion thickness was 5 mm, with an intersection gap of 1
mm. In all cases (n = 21), T1 weighted (coronal-saggital
and axial) images enhanced with gadolinium diethylenet-
niaminepentaacetic acid (10 ml) were obtained.
CT examinations had been performed with 16 slice
system (Philips Medical Systems MX 8000 IDT Multislice
CT System-V 2.5) in 34 cases or with 64 slice system
(Siemens 64 slice CT, Leonardo Running Space) in 9
cases. During all CT examinations, transverse slices of 2
mm in thickness were obtained from the top of the
frontal sinus to the base of the maxillary sinuses. Then,
raw data was reconstracted to 1 mm section thickness. IV
contrast material (ioheksol, 300/100, 1.5 mg/kg) was ad-
ministered in 7 patients and all images were also docu-
mented using both soft-tissue and skeletal window set-
ting.
All cases that were included in the study had pathologic
lesions arising from the nasal septum, nasal passage
walls, conchae or the paranasal sinuses, which invaded or
obstructed the nasal passage. Common variations such as
simple concha bullosa, paranasal sinus derived simple
retention cysts, allergic rhinitis, nonfungal rhinosinusitis
or nasal polyposis were excluded.
3. Results
Benign cases (n = 48) consisted of nasal alar hemangioma
(n = 1), nasal angiofibroma (n = 1), columellar dermoid
cyst (n = 1), fibrous dysplasia of the maxillary sinus (n =
5), pleomorphic adenoma (n = 1), antrochoanal polyp (n =
4), sphenochoanal polyp (n = 1), inverted papilloma (n =
6), complicated concha bullosa (n = 6), rhinolith (n = 4),
mucocele (n = 6), atypical retention cyst (n = 4), fungal
destructive sinusitis (n = 3), nasoethmoid encephalocele
(n = 4), nasal paraganglioma (n = 1). Malignant cases (n
= 18) consisted of lethal midline granuloma (n = 3),
sinonasal lymphoma (n = 5), chondrosarcoma (n = 2),
squamous cell carcinoma (n = 4), melanoma (n = 1),
adenoid cystic carcinoma (n = 1), esthesioneuroblastoma
(n = 1), sinonazal Ewing sarcoma (n = 1). Our study
group was consisted of many lesions which includes
many of the reported nasal cavity masses (Table 1).
All cases had varying degrees of nasal obstruction. In
Table 1. A detailed practical classification scheme for the nasal cavity masses.
PRIMARY MASS LESIONS
BENIGN MALIGNANT
SECONDARY MASS LESIONS INFECTIOUS-INFLAMATORY
*Osteoma *Squamous cell carcinoma
*Metastasis (renal cell carcinoma, lung,
breast)
*Inflamatory polyps
*Inverted papilloma *Adenocarcinoma
*Minor salivary gland tumors *Adenoid cystic carcinoma
*Mucocele, atypical retension
cysts
*Angiofibroma
(locally agressive)
*Esthesioneuroblastoma *Rhinolithiasis
*Polyps
(antrochonal, sphenochonal)
*Lymphoma *Granulomatous destruction
(wegener’s disease)
*Hemangioma, dermoids and
miscellaneous
*Sarcomas *Fungal sinusitis
*Malignant melanoma
*Invasion-infiltration from surrounded
area (meningioma, chordoma, lymphoma,
paranasal sinus tumors).
*Miscellaneous
CONGENITAL IDIOPATHIC
*Fronthoethmoid encephalocele *Fibrous dysplasia
*Glioma *Midline granuloma
*Teratoma
*Dermoid-Epidermoid cyst

D. YILDIRIM ET AL.
12
fully ossified lesions (rhinolitis, osteoma, fibrous dysplasia)
diffuse hypointensity on MRI and sclerosis on CT was
accepted as benign. Smoothly bordered nonenhanced le-
sions (cysts, secretions, mucoceles) were easily defined
in both CT and MRI but better characterized with en-
hanced MRI images. On the other hand masses with
smooth borders but enhanced differently from mucoceles or
retention cysts were diagnosed as nerve tissue (Schwan-
noma, Paraganglioma) or minor salivary gland (pleomor-
phic adenoma) tumors. Uniform contrast enhancement
was associated with hemangioma or angiofibroma. Ne-
crosis, invasion or destruction were associated with ma-
lignant neoplasms, granulomatous reactions, fungal in-
fections or metastases. Identification of lipomatous con-
tent on cross-sectional images was associated with dermoid-
epidernoid lesions. Other lesions that associated with
cranial vault (fronthoethmoid encephalocele, estesioneu-
roblastoma, chordoma, meningioma) were easily diagnosed
by typical appearences (Scheme I).
4. Discussion
Prolonged irritant dust inhalation, smoking, nickel,
chrome, radium, isopropyl alcohol, toxic gases such as the
mustard gas constitutes the etiology of the nasal cavity
tumors. Throughout life, radiation exposure (diagnostic or
therapeutic), immunosuppression or lesions that carry the
risk for malignant degeneration such as the inverted
papilloma increases the frequency of the malignant lesions
[2,3]. However, nasal cavity malignant lesions are rare, but
the similar clinical features of the benign and malignant
lesions in the beginning may delay the diagnosis [4].
Inflammatory diseases constitutes another group for dif-
ferential diagnosis; destruction and erosions of the organ
mimic the malignant lesions and may be misdiagnosed [4,
5]. The lesion, benign, malignant or inflammatory must be
accurately and quickly diagnosed within these complexity
and the final biopsy must address the lesion [4,5]. Especially
cases with recurrent, prolonged, unilateral blockage despite
the medical therapy and diplopia, proptosis, cranial nevre
paralysis must receive paranasal cross-sectional scans [6].
Although the clinical symptoms help to identify a lesion to
some extent, it is hard to describe the localization, config-
uration or the possible invasion of the lesion. If suspected,
cross-sectional imaging of the nasal cavity and adjunctive
anatomical boundaries must be performed.
In the nasal cavity lesions; detailed examinations of the
paranasal sinuses, orbita, intracranial fossa, pterygomaxil-
lary and pterygopalatine fossae and the infratemporal cavity
must be made. Adjunctive anatomical invasions both deter-
mine the therapeutical approaches and give an idea of the
rate of the morbidity and mortality [3,4].
These wide-range nasal cavity/paranasal sinus derived
tumors are approximately 70% benign and 30% malig-
nant [1]. In a classification including also our cases, it is
shown that tumors arising from this region or lesions
mimicking the tumors are not so rare (Table 1).
Among these lesions, the most frequent malignant le-
sion is the squamous cell carcinoma and the most benign
lesion is the osteoma. Imaging characteristics, in order as
shown in the table are;
 Osteoma and similar sclerotic dense lesions in the
X-ray; first a radiography then the CT provides de-
tailed information about the contour, localization and
the nature of the lesion other than the MRI [7].
 Inverted papilloma is unilateral and arises from the
lateral nasal wall. Malignant transformation risk is
about 2% - 15%. CT provides information about the
oseous changes, remodelling more than destruction
and the slowly growing nature of the lesion. Despite
the internal contrast in the MRI, differential diagnosis
can be made with the intermediate signals other than
the high T2W signals of the malign lesions [8]. If
needed, both imaging modalities could be used to-
gether.
 Choanal polyps could be identified as the lesions ori-
ginated from the sphenoid or maxillary ostiums and
widen in the nasal cavity, thus narrowing the nasal
passage. Both CT and MRI could be used.
 Pleomorphic adenoma is a benign mixed tumor of the
salivary glands. Although it arises mainly in the ma-
jor salivary glands, pleomorphic adenoma arising with-
in the nasal cavity has rarely been reported in the lit-
erature [9]. Differential diagnosis is hard, but the puc-
tuate calcification in the CT is specific for the lesion.
Our case also had puctuate calcifications. These nasal
cavity derived well defined lesions may be identified
in the MRI, despite the heterogen contrast enhance-
ment, the T2W sequency may show the hypointense
capsule surrounding the lesion [9].
 Angiofibroma originates from the sphenopalatine for-
amen and involves both the pterygopalatine fossa and
the posterior nasal cavity [10]. In this lesion no evi-
dent destruction is observed through the air plans.
Both MRI and CT shows diffuse-homogen and dense
contrast enhancement without any necrotic or cystic
degeneration and is patognomical [10]. Another high-
ly vascularized benign lesion is hemangioma and in-
volvement of the nasal cavity is exceedingly rare.
Cross-sectional images may show masroscopic honey-
comb appearance [11].
 Encephalocele, glioma and dermoid cyst are the most
common midline (congenital) nasal masses. Given
their potential for intracranial extension, prompt treat-
ment is necessary to prevent complications. Although
CT is used in this group, the lipomatous content of the
lesion or the neural-parenchymal connections could be
viewed under the high resolution spin-echo T1W and
T2W coronal plans [1,12].

D. YILDIRIM ET AL. 13
One of our cases was lipomatous and the dermoid le-
sion content was measured as –123 Hounsfield Unit on
CT images. The other two benign midline lesions could
only be diagnosed with the MRI. The term “nasal glio-
ma” is often misleading; it has long been recognized that
they are not neoplasms but malformations, and the term
“heterotopia” has been referred [13].
Malignant nasal cavity tumors are 80% squamous cell
carcinoma and often originates from the maxillary sinus
(25% - 58%). 10% of the malignant tumors are adenocar-
cinoma and adenoid cystic carcinoma. Other malignant
tumors are extremely rare. Before they fill the nasal
cavity, they mimic the symptoms of the chronic sinusitis,
thus once diagnosed, they invade or infiltrate other struc-
tures [1]. Local osteolytic, perineural or perivascural in-
vasion or metastatic invasions to the lungs or skeleton
identified cross-sectionally addresses the malignant po-
tential of the tumor. Such lesions must be thoroughly
evaluated with thin section multi-planar images which
obtained by reconstruction in bony-tissue algorithm. Such
images permit to detailed evaluation of the cribriform
plates, fovea ethmoidalis, planum sphenoidale, posterior
frontal sinus wall, and the medial orbital roof. Once iden-
tified; malignant tumors of the nasal cavity are highly
cellular tumors with little free water, and they may con-
tain focal areas of hemorrhage or necrosis. This is re-
flected in their heterogenous MR imaging appearances
and a low-to-intermediate signal intensity on both T1 and
T2-weighted images contrary to benign ones [14].
Extranodal lymphoid tissue derived lymphomas are in
the malignant group that constitute less than 1% of the
nasal cavity tumors. They are often seen in the maxillary
or ethmoid sinuses [15,16]. They are often non-Hodgkin
lymphomas, mostly B cell lymphomas. Despite this group,
less aggressive T/NK cell lymphomas are rare but their
prognosis are worse. Advances in immunocytochemical
phenotyping have revealed that the majority of these
lesions are in fact either a form of non-Hodgkin’s lym-
phoma arising in the sinonasal tract [15,16]. Terms used
to refer to such lesions include Stewart’s syndrome, le-
thal midline granuloma, idiopathic midline granuloma,
idiopathic midline destructive disease, midline nonheal-
ing granuloma etc. [17]. These older terms have been
replaced in the pathologic diagnostic nomenclature of
sinonasal disease by new terminology that accurately
describes the cellular lineage and biological growth rate
[17]. And several attempts have been made to distinguish
the various types of midline destructive processes on the
basis of imaging findings. Imaging features of this group,
different than the other primary malignant nasal cavity
masses, are extensive destruction of thye osseous anato-
my that may lead to autorhinectomy on the CT images.
Our cases also had massive destruction that nearly erased
the anatomical structures. Once suspected, serological and
histopathological verification must be made at once. Only
the cross-sectional images may not be able to differ these
lesions from the sarcoma or Wegener granulomatosis
[17].
Primary nasal cavity originated malignant melanomas
are neural crest tumors that constitutes less than 1% of all
malignant melanomas. They arise mostly from the nasal
septum and turbinates. Melanoma must be suspected if a
mass is identified from the septum or a pathological focal
activity is observed in the nasal cavity during the irre-
levant whole body PET/CT scans. Differential diagnosis
can be made with MRI, by defining the hyperintensity of
the melanin pigment cantaining tumoral tissue [18]. We
accidentally determined the nasal dense FDG activity
during the PET/CT scan. It is also noted that, as all
malignant or inflammatory pathologies of the body, this
method is being used more frequently and proven effec-
tive [19,20].
Esthesioneuroblastoma (also called olfactory neuroblasto-
ma) is a rare cancer which develops in nerve tissue as-
sociated with the sense of smell. When diagnosed in its
early stages, esthesioneuroblastoma can often be treated
successfully with surgery, radiation and/or chemotherapy
(19). On CT and MR sections, the lesion is often cen-
tered near the cribriform plate. CT is useful for defining
bone destruction, whereas MR imaging best delineates
soft-tissue extension. In this context, the use of both
modalities is critical for discriminating between postob-
structive secretions and tumor tissue, as well as for de-
fining intracranial extension [19,21].
Focal osseous destructive masses of the nasal cavity or
paranasal sinuses that also have a soft tissue component
may be a sign for metastatic lesions. Generally a lesion
of this kind might be renal cell carcinoma, lung or breast
carcinoma metastasis and it is hard to differ from the
midline aggressive tumors. However, if suspected, the
PET/CT scans may identify the primary focus and dif-
ferentiate the lesion [1].
Benign lesions, although beyond the scope of this
study, will be briefly described as they have their part in
our algoritm. For example, the nasal polyps have both the
chronic inflammation and resorption of the sinunasal
structures, so the loss of the marginal sharpness is fre-
quent. Internal linear septal contrast enhancement is pat-
ognomic in the postcontrast cross-sectional scans [4]. An
important point for his group of patients is to prefer MRI
for the frequent need for the control scans in order to
minimize the amount of the ionized radiation [4]. Reten-
tion cysts and mucoceles may have different characteris-
tics of signals in the CT or MRI up to their content and
are not typical [4].
Today in the sinunasal pathologies, after the clinical
examination, if further examination is needed, excluding
the malignancies and detecting distant metastasis, con-

D. YILDIRIM ET AL.
14
trast enhanced CT or MRI or PET/CT is the preferred
technique. Soft tissue is better visualised by the MRI
where on the bony areas CT has more advantagious.
Additionally, PET/CT adds functional status of a lesion
semiquantitatively allowing to measure the tumor glucose
consumption. Thus, these cross-sectional methods can be
used tandemly. Especially invasion of the orbital roof,
cribriform plate, fovea ethmoidalis, posterior maxillary
sinüs wall, pterygopalatine fossa, erosion of the sphenoid
sinus wall represent the locally aggressive nature and
extranasal invasion of the tumor. The artefact free scans
could be better enhanced by the multidetector CT rather
than the conventional spiral ones [13]. On the other hand,
usually the ostiums of the sinuses are blocked in the
sinunasal tumors, so superimposing sinusitis, inflammatory
soft tissue deposits and the retention cysts may not
provide evident differentiation in the density in CT, they
may only be detected by the contrast enhanced multiplanar
MRI. In this context, MRI can also differentiate the
tumoral tissue from the surrounding edema, fluid or in-
flammation. Generally the sinunasal tumors have inter-
mediate intensity in the T1w and T2w sequences, thefore
even without contrast, T2w hyperintensity of the edema
and inflammation could be identified. Intracranial exten-
sions, especially the dural ones, can better viewed by the
contrast enhancement MRI examinations [13]. If sus-
pected, PET/CT could be used to measure both the met-
obolic activity and the aggressive nature of the lesion;
besides it could be used to control the response to the
treatment [22].
In summary, the mainstay of the radiologic examination
in the tumoral cases of the sinunasal cavity is far more
than to make a differential histopathologic diagnosis but
to explore the origin, dimensions, orientation of the mass
to the airway passage and nasal walls, contours and the
contrast enhancement of the tumor. Therefore the sur-
geon may be briefed preoperatively about the nature of
the mass and the need for biopsy (also including the
guidance) is questioned.
In conclusion, this study gives the cross-sectional hints
which might help assess the tumoral specifications, ex-
tensions, possible differential diagnoses and the most pro-
bable approaches in a practical algoritm that, to best of
our knowledge, is the first in the literature (Scheme I).
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Appendix
Scheme I. Hints for diagnosis of a mass which
presented by the obliteration of the nasal cavity.
Step by step to the lesion differentiation involving
nasal cavity with MRI and CT
 Benign: generally nonenhanced lesions
Rhinolith (mildly dense), fibrous dysplasia (ground-
glass density) or osteoma (very dense) (Figure 1), retention
cyst (nons-calloped osseous borders) or mucocele (scal-
loped-enhancing rim) with insiccipated secretions (Figure
2);
 Benign aggressive: With associated concomitant dis-
eases like diabetes, immune suppression
Fungal infections (mucormycosis);
 Malignant: Densely scattered or arch like calcific is-
lands throughout the tumoral stroma on CT images
Soft tissue sarcomas including calcification (osteo-
sarcoma, chondrosarcoma) (Figure 3).
Existence of the lipomatous content Figure 1. (a) Coronal CT section a case with rh inolith whi ch
shows an oval lesion with mild density with relatively lucent
central area seated next to the right middle meatus (arrow);
(b) After removal it is seen fragmented; (c) A densely scler-
osed lesion originated from inferior ethmoid cells and obli-
terates the left osteomeatal unite on the left side ; (d) Diff usely
thickened a nd acallope d border s of right ma xillary sin us me-
dial wall also narrows the right nasal passage.
 Dermoid (Figure 4), epidermoid lesions, postopera-
tive flap or repositioned graft (history!).
In the nonspecisifc appearence on both the T1w-T2w
MRI sequences, examination must be continued after
contrast administration.
 Mural enhancement
Sinusitis, mucocele (Figure 2), retention cyst;

D. YILDIRIM ET AL.
16
Figure 2. MRI examination of an ethmoid mucocele. (a) Hy-
perintense on coronal T2w image (arrow); (b) Hypointense
on T1w precontrast image (arrow ); (c) and (d) On these con-
trast enhanced coronal fatsaturated images, extention (ar-
rows in (c) and (d)) and origination (arrow in (d)) are seen.
Lesion enhanced only murally and showed no internal signal
increase on enhanced images. Endoscopic image shows the
lesion anphas e that emanating from th e eth moid recess.
Figure 3. Nasal (left: total, right: partially ) cavity aeration is
obliterated by the soft tissue mass that containing scattered
calcific islands (chondrosarcoma).
Figure 4. Nasal dermoid lesion. (a) Three-dimentional CT ap-
pearence of a columellar lesion; (b) Axial CT image shows
the hypodense, lipomatous lesion (arrow).
 Internal septal contrast enhancement
Polipozis (diffuse), polyp (pedinculated with smooth
contours), inverting papilloma (pedunculated with lobu-
lated contours, usually originated from osteomeatal unit)
(Figure 5);
 Erosion, necrosis or destruction with heterogenous
enhancement
Malignant lesions (Squamous cell carcinoma, adeno-
carcnoma, metastasis), Lymphoma, granulomatous dis-
eases (Figure 6);
 Homogenous and dense contrast enhancement
Figure 5. Certain polypoid nasal cavity masses. (a) Antro-
coanal polyp, originating from left maksillary sinus antrum
(arrow); (b) And extending to the left coanal passage (ar-
row); (c) A sphenocoanal polyp which originating from the
left sphenoid sinus ostium (arrow) with its vertical orien-
tation is diagnostic (arrow); (d) Although having somooth
(atypically) borders, erosion of the right inferior turbinate
chondrovomeral junction (arrow) direct the diagnosis to in-
verting papilloma.
Figure 6. Squamous cell carcinoma. (a) Obliteration of the
right nasal passage w ith a mass that has not obvious bor ders
that seated between right ethmoid cells and nasal cavity
(between arrows); (b) Unfortunately, erosion of the right cri-
briform plate and enhancement with frontobasal focal dural
thickening (arrow) shows the cranial involvement; (c) Also,
obliteration of the right frontonasal recess causes right fron-
tal sinusitis (arrow). Permits transfer to the dural surface of
anterior cranial fossa (b), (arrow).

D. YILDIRIM ET AL. 17
Figure 7. (a) Left nasal alar area located lesion causes par-
tially narrowed aeration and contains some hy podense tub-
ulolineary focuses (arrow), hemangiom; (b) At the poster-
osuperior pharyngeal location, an expansile mass lesion is
seen with scalloped anterior borders of the anterior wall of
the sphenoid sinus (arrow), angiofibroma.
Figure 8. Lymphoma. (a) An expansile nasomaxillary mass
causes facial asymmetry at 3D-CT volume rendered image;
(b) When the window settings are adjuste d to the bone level,
it is possible to see the destruction with free teeth; (c) Sag-
gitally reconstructed CT image shows the obliteration of the
nasal passage inferiorly (arrow).
Figure 9. Paraganglioma. (a) A small right nasal mass located
in middle meatus, causes accumulation of T1w hyperintense
secretion in the right maxillary sinus due to obliteration of
the right osteomeatal unit (arrow); (b) On postcontrast axial
T1w sequence, lesion enhanced densely and heterogenously;
(c) At the cytopathologic examination, it can be seen that tu-
mor is composed of cells which have pale eozinophilic cyto-
plasm and round nucleus. There is prominent vasculer net-
work separat ing th e tumor nests (H& E × 100 ).
Tubulary hypodense or hypointense vasculary traces
(hemangioma), Angiofibroma (infiltrative and expansile)
(Figure 7).
Pronounced midline destruction (can be diagnosed
Figure 10. Involvement of the palatum durum withan ex-
pansile lesion (paraganglioma) on coronal CT image (a), ar-
row); And on coronal T1w MRI image (b), aarrow; Pos-
tcontrast coronal fatsaturated T1w image shows the heter-
ogenously enhancement of the lesion (c), arrow; The epithe-
lial-myoepitehial islands of tumor in myxoid stroma (d)
(H&E × 200).
Figure 11. Fronthoethmoid encephalocele. (a) T2w corona
Benign
atous disease (Wegener);
 Figure 8), other primary malignant tumors
or smooth borders but enhanced differently
fr
l
sequence and (b) T1w postcontrast saggital image show the
continuity of left fronthobasal neural parenchyma thorough
the lef upper and middle nasal meati. This typical appearence
must be taken into consideration to prevent any dangerous
intervention. Because (c) similiar appearence may be pre-
sented in a malignant tumor of this region, esthesioneuroblas-
toma. Heterogenous tumoral enhancement after contrast in-
jection can differentiate both lesion (arrow).

Granulom
Malignant
Lymphoma (
metastases.
Masses with
om mucoceles or retention cysts
only with histopathological examination)

D. YILDIRIM ET AL.
18
nglioma) (Figure 9),
m
ic
Nerve tissue (Schwannoma, Paraga
inor salivary gland (pleomorphic adenoma) (Figure 10).
Cranial Vault Associated (can be diagnosed by typ-
al appearences)
 Benign
Fronthoethmoid encephalocele (a reces which contains
basla frontal gyri) (Figure 11);
 Malignant
Estesioneuroblastoma (Figure 11), Meningioma, Chor-
doma (typical location and appearences).