Symptom Finder - Nasal Mass or Swelling
NASAL MASS OR SWELLING
Although anatomy may assist somewhat in developing the differential here, it is probably an unnecessary exercise because the mnemonic MINT will bring to mind virtually all the etiologies.
M—Malformation reminds one of the broad nose of cretinism, Down syndrome, gargoylism, myxedema, and acromegaly.
I—Inflammation suggests carbuncles; cellulitis; syphilis; acne rosacea with rhinophyma; Wegener midline granuloma; and granulomas from tuberculosis, aspergillosis, rhinosporidiosis, mucormycosis, and other chronic infections.
N—Neoplasms suggest carcinomas of the external nares, squamous cell carcinoma of the nasal mucosa (such as Schmincke tumors), and nasal polyps secondary to allergic rhinitis.
T—Trauma reminds one of fractures, dislocations, and contusions, although these diagnoses are usually obvious.
Approach to the Diagnosis
The diagnosis is not difficult except in the case of granulomas and carcinomas, when skillful biopsy and culture are necessary. In Wegener midline granuloma, a search for alveolitis and glomerulonephritis will help to determine the diagnosis. Serum for ANCA antibodies is often diagnostic.
Other Useful Tests
1. CBC (infection)
2. Nasal smear and culture
3. Tuberculin test (tuberculosis)
4. Acid-fast bacillus smear and culture (tuberculosis)
5. VDRL test (syphilis)
6. Fungal smear and culture (mucormycosis)
7. X-ray of skull and sinuses (granuloma, neoplasm)
8. CT scan of brain and sinuses (sinusitis, neoplasm, granuloma)
9. Nasal smear for eosinophils (nasal polyps)
10. Nasopharyngoscopy (polyps, carcinoma)
11. Serum immunoglobulin E (IgE) level (allergic rhinitis)
12. Radioallergosorbent test (RAST) (allergic rhinitis)
13. Allergy skin testing (nasal polyps)
Although anatomy may assist somewhat in developing the differential here, it is probably an unnecessary exercise because the mnemonic MINT will bring to mind virtually all the etiologies.
M—Malformation reminds one of the broad nose of cretinism, Down syndrome, gargoylism, myxedema, and acromegaly.
I—Inflammation suggests carbuncles; cellulitis; syphilis; acne rosacea with rhinophyma; Wegener midline granuloma; and granulomas from tuberculosis, aspergillosis, rhinosporidiosis, mucormycosis, and other chronic infections.
N—Neoplasms suggest carcinomas of the external nares, squamous cell carcinoma of the nasal mucosa (such as Schmincke tumors), and nasal polyps secondary to allergic rhinitis.
T—Trauma reminds one of fractures, dislocations, and contusions, although these diagnoses are usually obvious.
Approach to the Diagnosis
The diagnosis is not difficult except in the case of granulomas and carcinomas, when skillful biopsy and culture are necessary. In Wegener midline granuloma, a search for alveolitis and glomerulonephritis will help to determine the diagnosis. Serum for ANCA antibodies is often diagnostic.
Other Useful Tests
1. CBC (infection)
2. Nasal smear and culture
3. Tuberculin test (tuberculosis)
4. Acid-fast bacillus smear and culture (tuberculosis)
5. VDRL test (syphilis)
6. Fungal smear and culture (mucormycosis)
7. X-ray of skull and sinuses (granuloma, neoplasm)
8. CT scan of brain and sinuses (sinusitis, neoplasm, granuloma)
9. Nasal smear for eosinophils (nasal polyps)
10. Nasopharyngoscopy (polyps, carcinoma)
11. Serum immunoglobulin E (IgE) level (allergic rhinitis)
12. Radioallergosorbent test (RAST) (allergic rhinitis)
13. Allergy skin testing (nasal polyps)
