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Imaging Findings

Pyogenic granuloma has no distinctive imaging features. CT shows a soft tissue density mass with lobulated contours more commonly arising from the nasal septum (Simo et al. 1998) (Fig. 8.42). Sinus opacification can be observed when the mass impairs any of the mucus drainage pathways. Bony remodeling is usually observed, while bony destruction has been described in a single case (Lance et al. 1992).

On MR, pyogenic granuloma exhibits intermediate to bright signal on T2 and hypointense signal on T1 sequences (Fig. 8.43). Relevant enhancement is observed after either Gd-based or iodine contrast administration (El-Sayed and Al-Serhani 1997). Angiography demonstrates the presence of several arteries converging into the lesion.

The differential diagnosis should be restricted to highly vascularized sinonasal masses: hemangioma, hemangiopericytoma, juvenile angiofibroma, paraganglioma and vascularized metastases (kidney, thy

Pyogenic Granuloma Nasal

Fig. 8.42a,b. Pyogenic granuloma. Plain CT, enhanced VIBE, axial plane. A polypoid mass occupies the right nasal fossa, indenting the medial maxillary sinus wall. This appears almost completely demineralized on CT (white arrowheads), whereas MR shows permeation of a residual hypointense periosteal layer (black arrows). CT density is unremarkable, bright and uniform enhancement is demonstrated on Gd-DTPA VIBE sequence

Fig. 8.42a,b. Pyogenic granuloma. Plain CT, enhanced VIBE, axial plane. A polypoid mass occupies the right nasal fossa, indenting the medial maxillary sinus wall. This appears almost completely demineralized on CT (white arrowheads), whereas MR shows permeation of a residual hypointense periosteal layer (black arrows). CT density is unremarkable, bright and uniform enhancement is demonstrated on Gd-DTPA VIBE sequence

Fig. 8.43a-c. Pyogenic granuloma. Endoscopy (a), TSE T2 (b) on axial plane, enhanced T1 on coronal plane (c). a Endoscopy of the right nasal fossa shows a pale polypoid mass completely filling the inferior meatus and displacing superiorly the inferior turbinate (IT). NS, nasal septum; MT, middle turbinate. The lobular capillary hemangioma has a hyperintense signal on T2 sequence, it turns around the septum to extend into the contralateral choana. At surgery, the lesion was demonstrated to arise from posterior nasal septum (arrows). c On the enhanced coronal T1 image a focal irregularity on the right surface of the nasal septum (arrows) is seen. The inferior turbinate is displaced superiorly (arrowheads)

Fig. 8.43a-c. Pyogenic granuloma. Endoscopy (a), TSE T2 (b) on axial plane, enhanced T1 on coronal plane (c). a Endoscopy of the right nasal fossa shows a pale polypoid mass completely filling the inferior meatus and displacing superiorly the inferior turbinate (IT). NS, nasal septum; MT, middle turbinate. The lobular capillary hemangioma has a hyperintense signal on T2 sequence, it turns around the septum to extend into the contralateral choana. At surgery, the lesion was demonstrated to arise from posterior nasal septum (arrows). c On the enhanced coronal T1 image a focal irregularity on the right surface of the nasal septum (arrows) is seen. The inferior turbinate is displaced superiorly (arrowheads)

roid, lung, breast). Unfortunately, among these, exclusively juvenile angiofibroma holds pathognomonic features (site of origin, presence of intralesional vascular flow voids, age, and male sex of patients). As a consequence, pyogenic granuloma can be suspected only by matching imaging findings and clinical history (female sex, age in the range 20-40 years, pregnancy, site of origin of the lesion).

cavernous hemangiomas arise from the maxillary sinus (Kulkarni et al. 1989), while capillary heman-gioma more frequently is seen at the nasal septum (Iwata et al. 2002; Kilde et al. 2003) and is characterized by a dense enhancement on both CT and MR. Furthermore, adjacent bony structures are usually remodeled rather than eroded (Dillon et al. 1991).

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