299 An Unusual Nasal Lump
Abstract A 70-year-old man received a few courses of various antibiotics for left dacrocystitis under the care of ophthalmologists. Despite the treatment, the lump was not improving. The patient, in the meantime, presented to his GP with recurrent left-sided epistaxis and it became apparent that he was also experiencing ipsilateral nasal blockage. He reported a 3-year history of left-sided tinnitus but no other red flag symptoms. He was subsequently referred as 2-Week-Wait to ENT and nasoendoscopy revealed complete blockage of the left nostril with the postnasal space fully obstructed by enlarged mucosal tissue and no palpable lymph nodes. CT showed an aggressive locally invasive sinonasal tumour and a necrotic posterior mediastinal lesion. MRI further defined the extent of invasion and revealed a significant level 2 lymph node. A gastroscopy and EUA nose were arranged to obtain histology to confirm the differential diagnosis of sinonasal SCC. This case highlights the importance of lateral thinking when presented with a refractory symptom, as a more sinister diagnosis can be detected earlier. It also reinforces the need for examination of surrounding anatomy that may influence the condition.