Congenital Midline Nasal Lesion
Michelle A. Michel, MD
DIFFERENTIAL DIAGNOSIS
Common
Nasal Dermal Sinus
Frontoethmoidal Cephalocele
Sinonasal Hemangioma
Nasal Choanal Atresia
Less Common
Nasal Glioma
Rare but Important
Pyriform Aperture Stenosis
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
Nasal dermal sinus and cephalocele: Intracranial extension and associated cysts/dermoids are important to identify at imaging
MR is best imaging tool to evaluate extent of dermal sinuses and cephaloceles
CT is modality of choice for evaluating bony narrowing in choanal atresia and pyriform aperture stenosis
Helpful Clues for Common Diagnoses
Nasal Dermal Sinus
Clinical clue: Pit may be present along nasal dorsum
CT/MR: Fluid density or signal intensity tract from nasal tip to enlarged foramen cecum traversing nasal septum
Bifid crista galli may be present
Associated craniofacial anomalies possible
Frontoethmoidal Cephalocele
Clinical clue: Nasoglabellar or intranasal mass that may change in size with crying
MR: Extension of meninges, CSF, and brain tissue through bony defect in cribriform plate or between frontal and nasal bones
Sinonasal Hemangioma
Clinical clue: Soft, reddish mass; capillary type most common; often arises from nasal septum
MR: Well-defined mass; T2 hyperintense; diffusely enhancing
Nasal Choanal Atresia
Clinical: Respiratory distress in newborn if bilateral; later presentation if unilateral
CT: Membranous or bony; unilateral or bilateral; thickened posterior vomer
Helpful Clues for Less Common Diagnoses
Nasal Glioma
Clinical clues: Subcutaneous blue or red mass on nasal dorsum (extranasal type); polypoid submucosal mass (intranasal type)
MR: Intra- or extranasal soft tissue mass
MR signal typically NOT similar to brain parenchyma; no connection to intracranial contents
Helpful Clues for Rare Diagnoses
Pyriform Aperture Stenosis
Anterior nasal bony stenosis
Look for central megaincisor and midline intracranial anomalies
