Bulge on the outside of the nose

Introduction The external expansion of the nose is more common in the active period of malignant granuloma. Nasal ventilation is not smooth or completely blocked, there are purulent sputum, often smelly. The general condition is acceptable, sweating, poor appetite, often low fever, a few have high fever, and treatment with general antibiotics is ineffective. Local examination showed swelling of the nasal mucosa, erosion and even ulceration, granulation, grayish white necrosis on the surface. More involvement of the inferior turbinate or nasal septum, obvious can cause external expansion of the nose, lesion development can cause perforation of the nasal septum or perforation of the ankle.

Cause

More common in the active period of malignant granuloma.

an examination

Related inspection

Nasal endoscopy, otolaryngology, CT examination, general radiography

Nasal ventilation is not smooth or completely blocked, there are purulent sputum, often smelly. The general condition is acceptable, sweating, poor appetite, often low fever, a few have high fever, and treatment with general antibiotics is ineffective. Local examination showed swelling of the nasal mucosa, erosion and even ulceration, granulation, grayish white necrosis on the surface. More involvement of the inferior turbinate or nasal septum, obvious can cause external expansion of the nose, lesion development can cause perforation of the nasal septum or perforation of the ankle.

Differential diagnosis

According to the characteristics of the lesion and pathological changes, malignant granuloma can be classified into two categories, which need to be identified.

1. Tumor-like type: The lesions are mostly in the nose, and also in the upper jaw, the pharynx, and then the nose. The lesion is mainly located in the midline of the face and the upper respiratory tract. It is mainly caused by granulomatous ulcer and necrosis. It is very destructive and can invade bone and cartilage, resulting in disfigurement. Most patients with advanced disease died of major bleeding or failure, and there was no arterial inflammation in the autopsy material. The pathological changes of this disease are quite different, mainly found in the following four types:

(1) Non-specific inflammatory granulation tissue contains various forms of inflammatory cells;

(2) Non-specific inflammatory granulation tissue contains a large number of tissue cells;

(3) Non-specific inflammatory granulation tissue has obvious necrosis;

(4) Non-specific inflammatory granulation tissue contains many giant cells.

The above four types are mostly mixed, and often are mainly lymphocytes, mixed with a considerable number of plasma cells and a number of tissue cells. These cells have a tendency to infiltrate around the blood vessels centered on the blood vessels. Although these cells have moderate atypia, they cannot be diagnosed as malignant tumors. Although the pathological changes of Wegener granuloma are also non-specific granulomas, they are characterized by multinucleated giant cells and necrotizing vasculitis. This is a pathological change of malignant granuloma and Wegener granulomatosis, although it is also a non-specific granuloma, but it is characterized by There are multinucleated giant cells and necrotizing vasculitis, which is the differential diagnosis criteria for malignant granuloma and Wegener granulomatosis.

2, allergic type: (autoimmune type) Wegener granuloma belongs to this type, can be divided into two types: localized and systemic. Mainly due to vascular allergic inflammation, in addition to multiple granuloma, more intractable ulcer necrosis. It can be limited to the upper respiratory tract, and can also affect the lungs and organs of the body. Invasion of the lungs presents multiple nodules, often with cavities; involving the kidneys with focal necrosis, glomerulonephritis; lesions can cause systemic vascular damage, fibrous exudates and granulation tissue in the middle of the blood vessels. Wegener's granuloma ulcers are painstakingly carried out in the body and involve organs such as the nose, upper jaw, pharynx, larynx, trachea, kidney, spleen, adrenal gland and lungs, which can die from systemic failure and uremia.

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