British Journal of Radiology (2006) 79, 269-270
© 2006 British Institute of Radiology
doi: 10.1259/bjr/50814804
An intranasal mass
K Gowda, MD,
M Farrugia, MD, FRCR and
C Padmanathan, FRCR
Department of Radiology, Newham University Hospital, Glen Road, Plaistow, London E13 8SL, UK
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Introduction
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A 10-year-old male child with suspected nasal polyposis was referred for an MRI examination by the ear, nose and throat (ENT) surgeon (Figure 1). What is the diagnosis?
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Figure 1. (a,b,c) Coronal T1 weighted, T2 weighted, (d) axial T2 weighted spin echo sequences and (e) sagittal T1 weighted images.
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Intranasal encephalomeningocele
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Anterior encephalocele is a rare condition and only a few large series have been published in the literature. Surprisingly, the incidence is much higher in Southeast Asian countries, including some parts of India. Frontoethmoidal encephaloceles are the most common type, followed by the nasopharyngeal and orbital types. Among the frontoethmoidal encephaloceles, the nasoethmoid variation is the most common type, and these patients present with swelling over the bridge of the nose with significant hypertelorism and orbital deformities. The nasopharyngeal type remains occult and presents with nasal obstruction or cerebrospinal fluid (CSF) rhinorrhoea. Rarely, the patient may present with meningitis [1]. The successful correction of frontoethmoidal encephaloceles has been shown to depend on the detailed understanding of the pathological anatomy [2].
MRI is the best modality for imaging encephalomeningocoeles as accurate information regarding the origin and site of herniation can be obtained with minimal invasiveness.
In MRI, nasal encephaloceles are always identified as complex masses of mixed soft tissue and CSF intensity that are contiguous with intracranial cerebral matter. Sometimes, differentiation of actual cortical grey matter and subcortical white matter can also be made if a large part of the gyrus has herniated. The differential diagnosis includes a dermal sinus extending into the nasal cavity, also known as an intranasal dermoid and nasal cerebral heterotopias, more commonly known as nasal gliomas [3].
Received for publication May 31, 2005.
Accepted for publication June 27, 2005.
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References
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- Mahapatra AK, Suri A. Anterior encephaloceles: a study of 92 cases. Pediatr Neurosurg 2002;36:113–8.[CrossRef][Medline]
- Holmes AD, Meara JG, Kolker AR, Rosenfeld JV, Klug GL. Frontoethmoidal encephaloceles: reconstruction and refinements. J Craniofac Surg 2001;12:6–18.[Medline]
- Barkovich AJ, Vandermarck P, Edwards MS, Cogen PH. Congenital nasal masses: CT and MR imaging features in 16 cases. AJNR Am J Neuroradiol 1991;12:105–16.[Abstract]
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Introduction
Intranasal encephalomeningocele
