NASAL MASS OR SWELLING

Although anatomy may assist somewhat in developing the differential here, it is probably an unnecessary exercise because the mnemonic MINT will bring to mind virtually all the etiologies.

1. M—Malformation reminds one of the broad nose of cretinism, Down syndrome, gargoylism, myxedema, and acromegaly.
2. I—Inflammation suggests caruncles, cellulitis, syphilis, acne rosacea with rhinophyma, Wegener midline granuloma, and granulomas from tuberculosis, aspergillosis, rhinosporidiosis, mucormycosis, and other chronic infections.
3. N—Neoplasms suggest carcinomas of the external nares, and squamous cell carcinoma of the nasal mucosa (such as Schmincke tumors), and nasal polyps secondary to allergic rhinitis.
4. T—Trauma reminds one of fractures, dislocations, and contusions, although these diagnoses are usually obvious.

Approach to the Diagnosis

The diagnosis is not difficult except in the case of granulomas and carcinomas, when skillful biopsy and culture are necessary. In Wegener midline granuloma, a search for alveolitis and glomerulonephritis will help determine the diagnosis. Serum for ANCA antibodies is often diagnostic.

Other Useful Tests

1. CBC (infection)
2. Nasal smear and culture
3. Tuberculin test (tuberculosis)
4. AFB smear and culture (tuberculosis)
5. VDRL test (syphilis)
6. Fungal smear and culture (mucormycosis)
7. X-ray of skull and sinuses (granuloma neoplasm)
8. CT scan of brain and sinuses (sinusitis, neoplasm granuloma)
9. Nasal smear for eosinophils (nasal polyps)
10. Nasopharyngoscopy (polyps, carcinoma)
11. Serum IgE level (allergic rhinitis)
12. Radioallergosorbent test (RAST) (allergic rhinitis)
13. Allergy skin testing (nasal polyps)

Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.

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• Back to symptom: Enlarged testicle: Introduction (review 16 causes)
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More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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