Pediatric nasal obstruction: a rare differential diagnosis

Introduction

The lobular capillary hemangioma (LCH), also known as pyogenic granuloma, is a benign tumor of the skin or mucosa, the etiology is still unclear. Clinically, it typically presents as a red-livid papule with rapid growth and a tendency to bleed.

Case presentation

A 13-year-old patient presented with nasal obstruction on the left with rhinorrhea and intermittent epistaxis for 2 months. Sinusitic complaints and allergic diathesis were denied. The clinical examination showed a contact-vulnerable, reddish lesion, which completely obstructed the left nasal cavity. The MRI showed a lesion with strong contrast enhancement and without connection to the retropharyngeal space or the fossa pterygopalatine. Due to severe vascularization and suspected vascular abnormalities, angiography with embolization was performed preoperatively. 24 hours after the intervention, a livid-reddish, smoothly demarcated, spherical mass was seen intraoperatively behind the inner nasal valve on the left with an attachment to the anterior septum, which inserted there with a broad base. Despite embolization, the tumor was vulnerable and bleeding easily and could be removed in toto by resection of the perifocal mucosal insertion site on the septum while sparing the cartilage without major bleeding (30*15*8mm). The pathological work-up established the diagnosis of LCH (CD31 +, WT-1 +, CD10 -). The patient could be discharged for further treatment after a few days.

Conclusion

LCH is a differential diagnosis of unilateral nasal obstruction, especially rare in children. Radiological examinations and, if necessary, embolization are recommended. The treatment of choice is complete surgical resection.

 

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Conflict of Interest

The author declares that there is no conflict of interest.

Publication History

Article published online:
24 May 2022