The “Quadra-Bullosa”: A Novel Case of Quadruple Septated Concha Bullosa

A 69-year-old gentleman presented with chronic nasal congestion and recurrent sinus infections. Physical examination was notable for a leftward septal deviation and moderate inferior turbinate hypertrophy. Nasal endoscopy did not reveal polyps, purulence, or significant middle meatal edema. After a period of conservative treatment with daily nasal steroid spray and sinus rinses, he underwent imaging for persistent symptoms. A computed tomography scan demonstrated ostiomeatal obstruction, septal deviation, and bilateral concha bullosa (CB) of both the middle and superior turbinates. The CB of the left middle turbinate was especially unique given the 4 separate septations (Figure 1A and B).