Diagnostic characteristics of sinonasal organizing hematomas: avoiding misdiagnosis

Abstract

Sinonasal organizing hematomas are rare lesions of the paranasal sinuses whose clinical characteristics lead to misdiagnoses of benign or malignant neoplasms. Endoscopy, preoperative biopsy, and computed tomography (CT) imaging do not lend helpful information in differentiating these lesions from more worrisome neoplastic processes. However, MRI can lead to positive diagnosis by recognizing the distinct outer rims of T2 hypointensity typically seen in these lesions.

Sinonasal organized Hematoma: Clinical features of seventeen cases and a systematic review

“…It is known that the maxillary sinus is most commonly associated with OH, and one particular author described it as an “organizing hematoma of maxillary sinus (OHMS).” To our knowledge, only one reported case of OH has occurred outside the maxillary sinus (sphenoid sinus) . We experienced two cases of organized hematoma that occurred outside of the maxillary sinus—a frontal sinus OH (Fig.…”

“…4 To our knowledge, only one reported case of OH has occurred outside the maxillary sinus (sphenoid sinus). 7 We experienced two cases of organized hematoma that occurred outside of the maxillary sinus-a frontal sinus OH (Fig. 4A,B) and a sphenoid sinus OH (Fig.…”

“…The association of OH with bleeding disorders, such as coagulation factor deficiency, end stage renal failure, or liver cirrhosis, has been well described in the literature. [7][8][9][10] Bleeding tendency in the body would be one of the important etiologic factors in terms of the OH pathophysiology, as previous studies have described. 1,2 There was one patient in this series who had coagulopathy due to warfarin therapy and had sphenoid sinus OH.…”

The increasing incidence of paranasal organizing hematoma: a 20-year experience of 23 cases at a single center

“…These two findings (bony destruction of the medial maxilla and hypointensity of the periphery on T2-weighted imaging) can differentiate OHs from malignancies (11) . OH is confirmed on histopathology, which shows hemorrhage, dilated vessels and peripheral fibrosis.…”

Magnetic Resonance Imaging in Sinonasal Disease

“…The hematoma will show an expansile mass with heterogenous T1 and T2 signal, peripheral T2 signal loss, and heterogenous enhancement. 50 CONCLUSIONS Uncomplicated rhinosinusitis accounts for the majority of sinonasal disease and does not usually require imaging in the diagnosis and management. When imaging is required, CT will often provide adequate characterization of sinonasal disease processes.…”