0:01

I wanna mention one bizarre entity

0:03

of the paranasal sinuses, which can be quite confusing.

0:07

And this is the Cy Nasal Organizing Hematoma.

0:12

This is an example of the Cy Nasal Organizing Hematoma.

0:15

Here on T one Wade Scan, we have a mass which is associated

0:19

with the maxillary antrum, which shows erosion

0:21

of the medial wall.

0:23

It has somewhat heterogeneous signal intensity on the T one

0:26

wayed scans on the T two wayed scan.

0:29

It's dominated by the dark signal intensity at the periphery

0:33

and centrally within the region,

0:35

although you can see that it is quite heterogeneous.

0:37

Here is some obstructed secretions anteriorly

0:41

on the post gadolinium hand scan.

0:44

It may show peripheral rim enhancement as well

0:47

as fron like central enhancement.

0:50

This could represent something you might think about, maybe

0:54

again, a fungal infection because it's bright on T one

0:58

and dark on T two.

1:00

But this heterogeneity to the signal

1:02

and the mass effect of it,

1:04

and the unusual pattern of enhancement

1:08

raises the possibility of a sino nasal organizing hematoma.

1:12

This is basically a reactive change

1:16

to inflammatory conditions.

1:18

It may have predisposing conditions in regard to patients

1:22

who have, for example, coagulopathies,

1:24

but it's basically a hemorrhage in the sinus,

1:28

which keeps it growing and growing

1:30

and growing, sort of almost analogous

1:32

to a cholesterol granuloma,

1:34

but with more of an aggressive erosion of the bone.

1:39

And it is an entity that was, again, described largely

1:42

by my good friend Jim Reich, as a mass like lesion

1:47

that is non-plastic in the perinasal sinuses.