Organized Hematoma of the Maxillary Sinus: Rapid Progression and Complications

Abstract

An organized hematoma of the maxillary sinus (OHMS), also known as a pseudotumor, 1) hematoma, 2) hematoma-like mass, 3) and organizing hematoma, 4) presents as an enlarging maxillary sinus mass which is associated with local bone destruction and which mimics a malignancy. However, it has been reported previously that cases of OHMS have benign clinical manifestations and do not recur or present with further complications after complete surgical evacuation. [3][4][5][6][7][8][9] Herein, we report a case of OHMS which was complicated by facial and orbital abscesses. The OHMS showed marked enlargement and extensive bone destruction that had occurred during an 8-month period. We believe that this case will facilitate an understanding of the rapid progression of OHMS, as well as outline the risks posed by the condition. CaseAn 88-year-old woman presented with a 3-month history of left-sided, recurrent nasal bleeding. She also complained of left-sided nasal obstruction, nasal purulence, and headache. The patient's medical history was unremarkable except that she had previously had a cataract of the left eye, which had caused significant visual loss. She has never taken anticoagulants such as aspirin or warfarin. Endoscopy revealed a polypoid mass which bled readily occupying the left nasal cavity. In addition, CT scans showed an expansile, heterogeneous, enhancing mass in the left maxillary sinus (Fig. 1). We assumed this was an OHMS, and planned endoscopic sinus surgery accordingly. We also intended to perform a preoperative biopsy to dismiss the possibility of a paranasal neoplasm. However, the patient declined further evaluation and was lost to follow-up. After 8 months, she sought assistance in the An organized hematoma of the maxillary sinus (OHMS) is a rare, benign lesion with locally destructive behavior. Although various clinical manifestations of OHMS have been reported previously, their associated complications and rapid progression have not yet been described. Herein, we report a case of OHMS that was further complicated by facial and orbital abscesses. Intensive treatment was necessary to prevent complications and progression of the condition. Korean J Otorhinolaryngol-Head Neck Surg 2016;59(2):150-4 Key WordsZZAbscess ㆍEpistaxis ㆍHematoma ㆍMaxillary sinus.

Sinonasal organized hematoma: Case report and review of the literature

“…Finally, neovascularization occurs, and these immature, frequently leaky blood vessels predispose the lesion to additional episodes of bleeding. These additional episodes of bleeding restart the vicious cycle resulting in hematoma enlargement with destructive changes to surrounding structures [7] . Because the maxillary sinus is the largest paranasal sinus and can be associated with negative pressure, it is believed that hemorrhage anywhere within the sinonasal cavity has a predisposition to accumulate within the maxillary sinus, thus potentially explaining the predilection of organized hematomas to occur in this location [8] .…”

“…Because the maxillary sinus is the largest paranasal sinus and can be associated with negative pressure, it is believed that hemorrhage anywhere within the sinonasal cavity has a predisposition to accumulate within the maxillary sinus, thus potentially explaining the predilection of organized hematomas to occur in this location [8] . In some cases, superinfection can occur and result in facial and orbital abscesses [7] .…”