SHM Converge Scientific Abstract ePoster Gallery-Unmasking a Hidden Path: A Nasal Lesion's Intracranial Journey

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This case describes a 15-month-old girl with a congenital midline nasal lesion initially thought to be juvenile xanthogranuloma. She presented with more than a week of worsening swelling and erythema over the lesion, without fever, trauma, drainage, or prior skin infection. A trial of cephalexin did not improve her symptoms.<br /><br />Because midline nasal lesions can represent nasal dermoid cysts with sinus tracts, which are sometimes missed and can extend intracranially, imaging was obtained when cellulitis developed. Laboratory studies were normal, but MRI and skull base CT revealed a well-circumscribed enhancing lesion on the nasal dorsum with an elongated midline tract extending to the foramen cecum, consistent with a nasal dermoid cyst with intracranial sinus tract extension.<br /><br />Plastic Surgery and Neurosurgery were consulted, and the lesion was successfully excised. She was treated with antibiotics during hospitalization and discharged after an uncomplicated recovery. The case highlights that midline nasal masses in infants require careful evaluation because clinical overlap with other lesions can delay diagnosis. Early imaging is important to identify dermoid cysts and sinus tracts, prevent infection or other complications, and guide definitive surgical management.

Asset Subtitle

Katarzyna M. Stoj

Meta Tag

Author List Katarzyna M. Stoj, Mirna Giordano

Category Clinical Vignettes

Concept Congenital Nasal Dermoid Cyst

Concept Midline Nasal Lesion

Concept Intracranial Extension

Concept Surgical Excision

Concept Sinus Tract

Distinguished Non-Finalist

Presenter Organization NewYork Presbyterian - Columbia and Cornell

Presenting Author Katarzyna M. Stoj

Track Pediatric

Keywords

midline nasal lesion

nasal dermoid cyst

intracranial sinus tract

infant nasal mass

cellulitis

MRI imaging

skull base CT

foramen cecum

surgical excision

plastic surgery neurosurgery

Congenital Nasal Dermoid Cyst

Midline Nasal Lesion

Intracranial Extension

Surgical Excision

Sinus Tract