A Case of Pyogenic Granuloma of the Nasal Cavity Required Preoperative Arterial Embolization

Abstract

Pyogenic granuloma is classified as a benign vascular tumor, and sex hormones, infection and trauma are known to be involved in its pathogenesis. The treatment is surgical resection, but the highly vascular nature of the tumor may cause massive bleeding at the time of resection. Therefore, preoperative evaluation of the tumor vascularity and treatment planning for bleeding are required. In this article, we report a patient with pyogenic granuloma of the nasal cavity that was thought to be caused by nasal foreign bodies who required two operations. The patient was a 29-year-old male, who presented with left rhinorrhea and nasal congestion. Examination revealed a tumor lesion with a smooth surface protruding from the left anterior nostril. CT revealed soft tissue in the left nasal cavity and multiple nodular shadows with high density areas within it, suspected as foreign bodies. At the first operation, resection of the tumor caused massive bleeding. We determined that it was difficult to continue the operation and completed it after ensuring hemostasis. Subsequently, we performed contrast-enhanced CT to evaluate the lesion vascularity. The findings revealed persistence of the foreign bodies in the left nasal cavity, and a tumor showing contrast enhancement around them. The tumor was assessed as being highly vascular. In the second operation, arterial embolization was performed, which controlled intraoperative bleeding, prior to the endoscopic sinus surgery. Pyogenic granuloma can be caused by long-term persistence of foreign bodies. Because of the high vascularity of these lesions, a contrast-enhanced CT should be performed to evaluate the lesion vascularity prior to its resection. Arterial embolization performed at the appropriate time controls the bleeding during resection.