A Concha Bullosa Mucopyocele Manifesting as Migraine Headaches: A Case Report and Literature Review

Abstract

A concha bullosa is a common anatomic variant that represents an aerated turbinate, usually the middle turbinate. It is usually asymptomatic. When extensively pneumatized, a large concha bullosa may cause significant problems, including headache, nasal obstruction, and blockage of sinus drainage. We report a case of a large concha bullosa mucopyocele that manifested as recurring migraine headaches. It was successfully treated with surgical excision. We also review the available literature.

Concha Bullosa Mucocele: A Case Series and Review of the Literature

“…1,7,11,17 However, mucoceles and mucopyoceles cannot be differentiated on CT. 18 The anticipated finding of a CBM on CT consists of a soft-tissue mass with a bony contour, which usually causes deviation or compression of surrounding structures. 6 There also can be enhancement on the periphery of the mass.…”

10-year-old with concha bullosa pyogenic mucocele

“…Surgical removal of the turbinate and thus the mucocele/pyomucocele is the standard procedure and usually relieves the patient from all symptoms. Interestingly, concha bullosas have been reported to cause migraine 7. In our case, the pyomucocele might explain the headaches, and certainly the nasal obstruction, but we cannot explain the neurological symptoms interpreted as aura by the paediatricians.…”

Radiology Quiz Case 2

“…9 The surgery should be extended as necessary to address all identified sites of obstruction and concomitant paranasal sinus disease. 4 In conclusion, a mucopyocele is an epithelial-lined, benign, expansile mass that is secondarily infected. Although it typically occurs in the paranasal sinuses, in rare cases it can develop in the concha bullosa of the middle turbinate.…”

“…3 It is lined with the same mucous membrane and possesses the same mucociliary transport system present in the paranasal sinuses, as well as an ostium connecting it to the frontal recess. 4 Therefore, obstruction of the ostium can lead to the development of a mucocele or mucopyocele. The first reported case of middle turbinate concha bullosa mucopyocele was by Badia et al in 1994.…”

“…In addition, she was diagnosed as having postobstructive sinusitis, which is seen in most patients with concha bullosa mucopyocele. 4 Since a mucopyocele presents as an intranasal mass with expansile features, the differential diagnosis can be quite broad. It includes neurofibroma, dermoid, meningocele, meningomyelocele, angiofibroma, lymphoma, inverted papilloma, carcinoma, plasmacytoma, schwannoma, and nasal foreign body.…”