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Imaging Diagnosis

The nose is most often involved with scleroma and Waters' (occipitomental), posteroanterior, lateral and submentovertex views of the nose and facial bones show thickening of the nasal mucosa, which may be either diffuse or more often polypoid in nature, sometimes with deviation of the nasal septum. There is expansion of the nasal cavity in the second and third stages of the disease, with large soft tissue masses occluding the nares (Figs. 38.4 & 38.5). The nasal bones may be thinned and eroded as a result of the enlarging polypoid masses filling the nose (Fig. 38.4); occasionally there may be thickening and sclerosis of the nasal bones.

The paranasal sinuses may become involved by direct extension or by occlusion of the sinus openings; the sinuses may become partially or totally opacified and may show air-fluid levels (Figs. 38.4 & 38.5).

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Fig. 38.4 Rhinoscleroma in a 45-year-old Nicaraguan female with nasal obstruction. (A) Waters', (B) posteroanterior, (C) lateral, and (D) coned lateral views of the nose and facial bones reveal large granulomatous masses completely occluding the nares and causing marked expansion of the nasal cavity. The nasal bone is elevated and thinned; the nasal septum appears partially eroded. The maxillary sinuses and lower portions of the ethmoid sinuses are opacified. There is agenesis of the frontal sinuses. Markedly poor dentition is also noted. (Courtesy of Dr. William Thomas, McLean, Virginia).

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Fig. 38.5 Rhinoscleroma in a 24-year-old Nicaraguan man. A large granulomatous mass occludes the left nares, seen best on the PA (A) and Waters' (occipitomental) (B) views with thickening also of the turbinates and ala of the right side of the nose. (C) The left paranasal sinuses are opacified, including the sphenoid sinus as seen on the submentovertex view. There is slight polypoid mucosal thickening in the right antrum also. (D) The marked bulbous deformity of the nose caused by the huge scleromatous masses in the nares, as well as the soft tissue nodules along the superior aspect of the nose, are seen best on the lateral film). This is the typical "Hebra nose" seen clinically. Note the lack of any destruction of the nasal bone, septum or plates. (Courtesy of Dr. William Thomas, McLean, Virginia).

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