Two Rhinoliths in a Single Nasal Cavity in an Elderly Patient Mimicking Fungal Sinusitis

Abstract

ABSTRACT Objective To highlight an interesting and a rare case of two rhinoliths in a single nasal cavity of an elderly male patient, mimicking fungal sinusitis or malignancy. To emphasize that rhinolith has to be considered in the differential diagnosis of unilateral nasal mass even in the elderly. Case report A 55-year-old man presented with a right-sided nasal obstruction, foul-smelling nasal discharge and a mass in the right nasal cavity of 6 months duration. Endoscopic examination revealed a gritty, blackish brown mass filling the entire right nasal cavity. A clinical differential diagnosis of malignancy or fungal sinusitis was made. CT scan of paranasal sinus was suggestive of fungal sinusitis following which patient was posted for biopsy. Intraoperatively, patient was found to have two separate masses in the right nasal cavity which were removed. We found a septal perforation adjoining the area where the rhinolith was impacted, with septum pushed laterally and adherent to middle turbinate. However, there were no features suggestive of malignancy. Histopathological examination also ruled out malignancy and confirmed a vegetable foreign body with calcification around an acellular material. Conclusion Rhinolith, though rare should be considered in the differential diagnosis of unilateral nasal mass in the elderly. How to cite this article Prasad V, Srinivas C, Krishnappa S, Rao STN, Rajanna HT. Two Rhinoliths in a single nasal Cavity in an Elderly Patient Mimicking fungal sinusitis. Clin Rhinol An Int J 2014;7(2):76-79.