Sinonasal Organized Hematoma Mimicking Nasal Polyposis

A 23-year-old woman presented with a 4-month history of recurrent nasal bleeding and left-sided nasal obstruction. She had no history of antecedent trauma, nasal surgery, or bleeding diatheses. Also, she denied no significant past medical history or anticoagulant drug use. General examination and complete hematology profile and coagulation tests were normal. On nasal endoscopy, 2 large polypoid masses were observed completely obstructing the left nasal cavity, without evidence of increased vascularity (Figure 1). Computed tomography (CT) scans of the paranasal sinuses (PNS) revealed an expansile heterogeneous opacification of the left maxillary sinus bulging into the left middle meatus and ethmoid sinus associated with partial destruction of the superior medial wall of the maxillary sinus (Figure 2). The opacification between left maxillary sinus and middle meatus consisted of patchy hyperattenuating areas centrally and circumferential hypoattenuation (Figure 2). Preoperative endonasal endoscopic biopsy was performed and showed inflammatory polyp. Under general anesthesia, the mass was completely removed using middle meatal antrostomy with endoscope. A friable dark reddish blood clot and thick fibrous tissue filled the maxillary sinus. After complete removal of the mass, the maxillary sinus mucosa was slightly edematous and kept intact. The lesion consisted of hematoma with fibrosis and angiogenesis (Figure 3). These findings were consistent with the organized hematoma. The patient remained asymptomatic 12 months after surgery.