CASE 13608 Published on 27.04.2016

Rhinolithiasis: case report of an uncommon foreign body

Section

Head & neck imaging

Case Type

Clinical Cases

Authors

Derdabi I, Edderai M, El Jouadi H, Aoujil F, El Fenni J

Hôpital Militaire Mohamed V;
Hay Riyad
11000 Rabat, Morocco;
Email:ilyasderdabi@gmail.com
Patient

21 years, female

Categories
Area of Interest Ear / Nose / Throat ; Imaging Technique CT
Clinical History
A 21-year-old woman was admitted to hospital complaining of gradually increasing right nasal obstruction, rhinorrhoea and headache present for several years. No history of inserting a foreign body was recalled.
Imaging Findings
A CT scan of the nasal cavity was performed and revealed a heterogeneous calcified irregular foreign body, lodged in the inferior meatus of the right nasal cavity (Fig. 1, 2, 3). There was no deviation of the nasal septum. No bony destruction was evident.

Anterior rhinoscopy revealed obstruction of the right nasal cavity by a hard irregular mass. This foreign body was extracted and the patient’s symptoms resolved.

Consequent pathological examination showed no evidence of malignancy.
Discussion
Rhinoliths are mineralized foreign bodies in the nasal cavity [1]. The term rhinolithiasis or rhinolith was first used in 1845.
Chemical examination made by Axmann in 1829 revealed that their general composition is a combination of inorganic (nearly 90%) and organic (around 10%) material [2]. Mineralogical analyses of rhinoliths have revealed that they may contain Whitlockite [(Ca, Mg)3 (PO4)2] and Dahllite [Ca5 (PO4, CO3)3OH] [3].
Symptoms are usually purulent rhinorrhoea and ipsilateral nasal obstruction. Less common are fetor, epistaxis, sinusitis and headache [3].
CT imaging can be performed whenever rhinolithiasis is suspected. It can precisely define the site and size of the rhinolith and identify any coexisting sinus disease. However, a calcified nasal mass should also raise the suspicion of other pathologic entities such as ossifying fibroma, odontoma, osteoma, exostosis or osteosarcoma [4].
Treatment is complete removal of the rhinolith, either by anterior rhinoscopy or nasendoscopy [5].
Differential Diagnosis List
Rhinolithiasis
Osteoma
Exostosis
Final Diagnosis
Rhinolithiasis
Case information
URL: https://eurorad.org/case/13608
DOI: 10.1594/EURORAD/CASE.13608
ISSN: 1563-4086
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