Sinonasal cavernous hemangioma, a diagnostic difficulty: a rare case report from Nepal

Introduction and importance: Cavernous hemangiomas, being rare, are difficult to diagnose, can cause therapeutic problems, and are often mistaken for other malignancies. We present a case of a middle-aged woman who was initially diagnosed with allergic fungal rhinosinusitis but was later confirmed to have a cavernous hemangioma of the right nasal cavity. Case presentation: A 28-year-old woman presented with a 3-year history of progressive nasal obstruction and mucoid, occasionally blood-tinged right nasal discharge. Physical examination revealed slight bulging of the right nasal dorsum. Vestibular examination demonstrated blood-tinged mucoid discharge pooling on the right side. Contrast-enhanced computed tomography demonstrated a soft tissue density completely obliterating the right nasal cavity with adjacent sinus involvement. Initially thought to be an inflammatory polyp, cavernous hemangioma was diagnosed after postoperative histopathology. Clinical discussion: Hemangiomas are mostly located in the anterior part of the nasal cavity, as this area is rich in blood supply and is more exposed. A retrospective study suggested that epistaxis is the most common presentation, followed by nasal obstruction and visual symptoms. Our patient presented with nasal obstruction and blood-tinged nasal discharge. Preoperatively, hemangiomas are often mistaken for other pathologies. Effective management of a nasal hemangioma involves wide resection of the mass along with the underlying mucosa and perichondrium. Conclusion: Nasal hemangioma can mimic other pathologies due to nonspecific clinical signs and symptoms, so it should be considered in the differential diagnosis of unilateral nasal masses. Comprehensive clinical history, examination, imaging, and histopathology are essential for accurate diagnosis and effective management.