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Bruno Cunha, Carla Conceição

Neuroradiology Department, Hospital Dona Estefânia e Hospital São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa

- 43rd ESNR Annual Meeting, 5 a 9 Outubro 2020
- Neuroradiology (2020) 62 (Suppl 1): S51. DOI: 10.1007/s00234-020-02534-5

INTRODUCTION: Nasal masses in children evoke a wide variety of conditions. They can arise from any element of the nose, often presenting as nasal dorsum or ala tumefactions or as obstructing lesions located within the nasal cavity. Alternatively, they can represent lesion extension from adjacent structures, such as the paranasal sinus, the maxilla and the nasopharynx. Clinical presentation is frequently non-specific. While some lesions may be readily apparent from birth, others may be perceived later on during the workup of nasal obstruction or epistaxis. Imaging studies are frequently key in the diagnosis and treatment planning of theses masses.
METHODS: We provide a pictorial review of nasal masses in children and depict the key and occasionally distinctive imaging findings that can guide the neuroradiologist towards an accurate diagnosis.
RESULTS: In our series we describe pediatric nasal masses from several etiological categories. Causes of nasal masses in children can be grouped into non-neoplastic and neoplastic lesions. Non-neoplastic lesions include congenital and developmental disorders, such as congenital nasolacrimal duct mucocele and the rare developmental midline masses, comprising dermoid/epidermoid cysts, cephalocele and nasal neuroglia heterotopia. Comparing to adults, inflammatory and infectious conditions such as mucocele, nasal or antrochoanal polyps and sinonasal polyposis are much rarer in children, and are frequently associated with cystic fibrosis or primary ciliary dyskinesia. Other miscellaneous non-neoplastic disorders may comprehend traumatic lesions and iatrogenic causes, such as presence of surgical material. Foreign bodies must also be taken into account, as young children commonly insert these in their nasal cavities. Regarding the neoplastic group, benign vascular tumours such as infantile hemangioma and juvenile angiofibroma can show characteristic imaging findings. Different benign neoplasms and neoplasm-like lesions can arise from the osseous structures, including giant cell tumor, fibrous dysplasia and ossifying fibroma. Malignant lesions may also occur, such as rhabdomyosarcoma or other sarcomatous tumours and nasopharyngeal carcinoma.
DISCUSSION & CONCLUSION: A wide variety of neoplastic and non-neoplastic conditions may present as nasal masses in children. While direct visualization might be sufficient in some cases, neuroimaging frequently has a crucial role in the management of these children. Knowledge of the most common causes and awareness for the key and sometimes distinctive imaging features can guide the neuroradiologist in the differential diagnosis. Further characterization of the lesion, determining its exact location, extension and, importantly, whether intracranial connection exists is critical for treatment planning and avoidance of a potentially devastating biopsy.

Palavras Chave: children; imaging; nasal masses; MRI; CT