Concha Bullosa Mucopyocele Presenting as a Nasal Mass

Abstract

Objective: 1) Describe the rare case of an adolescent with a concha bullosa mucopyocele presenting as a nasal mass. 2) Review the existing literature discussing mucopyocele of a concha bullosa.

Method: Case report of a 14-year old girl presenting to the emergency department with localized right-side facial pain, pressure, and headaches. The patient had no rhinorrhea, was afebrile, and had a normal white blood cell count and c-reactive protein.

Results: Sinus CT showed a right-side intranasal mass with destruction of middle turbinate bone. MRI revealed post-obstructive fluid throughout the maxillary, ethmoid, and frontal sinuses. The patient was taken to the operating room for biopsy of the presumed mass and drainage of the sinuses. A large, bulging middle turbinate was found on nasal endoscopy and incision into the turbinate revealed a purulent concha bullosa. The concha bullosa was opened and unilateral maxillary antrostomy and anterior ethmoidectomy performed. Literature discussing concha bullosa mucopyocele is limited to only a few case reports.

Conclusion: This describes an unusual case of an adolescent girl with a concha bullosa mucopyocele presenting as an obstructing mass of the middle meatus without signs or symptoms of infection. Although rare, an infected concha bullosa can cause significant problems by obstructing the entire osteomeatal complex.