case presentation - inverted papilloma

Report
CASE PRESENTATION
By – Dr Pulkit Agarwal
Particulars
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George Kurian
72 yrs
Christian
Harihar
Engineer
Chief Complaints
• Right sided nasal obstruction since 2 months
HOPI :
• Right sided, Insidious in onset, progressive, partial, no
positional variation, no diurnal variation
• H/O foul smell from nose (stopped after course of
antibiotic)
• No H/O Nasal Discharge
• No H/O chronic irritation in throat
• No H/O excessive Sneezing
• No H/O recurrent bleeding from nose
• No H/O Headache
• No H/O Ringing sensation in ear, ear pain or ear discharge
• No H/O recurrent cold
• No H/O reduced/altered sense of smell
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No H/O change in voice
No H/O significant loss of weight
No H/O Facial pain
No H/O trauma
No H/O loosening of tooth
No H/O double vision
Treatment History :
• Patient is a known diabetic on treatment since
14 yrs on (Metformin 750mg daily)
• Patient has taken a course of antibiotic
(amoxyclav), nasal decongestant drops
(xylometazoline), mucolytic for a span of one
week.
Past history :
• No H/O Hypertension, Bronchial Asthma,
Prolonged medication
• No H/O drug allergies (NSAID)
Personal history :
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Diet – Mixed
Appetite – Normal
Bowel and Bladder – Normal and regular
Sleep – reduced due to nasal obstruction
No addictions
Family history :
• No H/O similar complaints in family members
General physical examination
• Elderly male, moderately built and nourished,
cooperative and well oriented to time, place
person
• General Condition – Fair , Vitals – Stable
Pallor
Icterus
Cyanosis
Clubbing
Lymphadenopathy
Pedal edema
Absent
• Nose :
• External Appearance – No apparent external
deformity of nose.
• Cold Spatula test – decreased misting on Rt side
• ARE :
• Bilateral inferior turbinate visualised, left side
middle turbinate seen normally.
• Rt Nasal Cavity – pinkish fleshy polypoidal mass
seen at the level of middle turbinate completely
occupying the nasal cavity (middle turbinate not
visualised)
• Insensitive to touch, doesn’t bleed, soft in
consistency, can be probed all around except
laterally
• PNS Examination :
• EA – No apparent facial deformity
• No tenderness
• Throat examination :
• Oral cavity – No hard palate bulge, No loosening of teeth, no
oroantral fistula
• Oropharynx – normal
• PRE – normal
• Ear –
normal
• Neck Examination – No lymphadenopathy
• EYE – No proptosis, no diplopia
Systemic examination :
• CVS – S1S2 heard , no murmurs
• R/S – Bilateral NVBS+, No added sounds
• P/A – soft , no organomegaly
• CNS – no focal neurological deficit
Provisional diagnosis :
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? Antronasal polyp
? Inverted papilloma
? Mucocele Rt maxillary sinus
? Sinonasal malignancy

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