Pr e sen tat ion of C a seDr. Margo McKenna Benoit (Otolaryngology): An 11-year-old boy was referred to a pediatric otolaryngologist at the Massachusetts Eye and Ear Infirmary because of headaches and a right nasal mass. Bifrontal headaches had started approximately 5 years earlier; in recent months, the pain had been predominantly in the right supraorbital area. The patient had chronic nasal congestion with occasional rhinorrhea. Approximately 2 years earlier, a neurologist had made a diagnosis of migraine headache. Magnetic resonance imaging (MRI) of the head at that time showed no intracranial abnormalities, but the findings were interpreted as being consistent with sinusitis.Two months before presentation, the headaches became more frequent and severe. Plain radiographs of the sinuses obtained at another hospital showed a lesion with the density of bone in the right ethmoid region. The patient was referred to an otolaryngologist, who noted a reddish soft-tissue mass within the right nasal cavity. Endoscopic examination confirmed that the mass arose laterally to the right middle turbinate. The left nasal cavity was normal. Cranial-nerve function was intact. There was no palpable cervical lymphadenopathy. The remainder of the examination was normal. Computed tomography (CT) of the paranasal sinuses 10 days later revealed a heavily calcified mass centered in and expanding the right ethmoid sinus; there was complete opacification of the ipsilateral maxillary, anterior ethmoid, and frontal sinuses. The lesion contacted the roof of the ethmoid sinus but did not involve the upper nasal cavity or cribriform plate. There were no pathologically enlarged lymph nodes. The patient was referred to this hospital.He had no weight gain or loss, malaise, fatigue, fever, chills, anosmia, epistaxis, or visual symptoms. Several years earlier, he had sustained a traumatic right orbital fracture as a result of a baseball injury. He had also had a right femoral fracture requiring operative reduction and had undergone adenotonsillectomy for obstructive indications. His only medication was ibuprofen for headaches. He had no known drug allergies. There was a maternal history of migraine headache. He was a sixth grader in the public school system and had recently received a diagnosis of a learning disability. He had not traveled recently and had no known exposure to infectious diseases.