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Sinonasal Melanoma on MRI: When Unilateral Nasal Obstruction Reveals an Aggressive Mucosal Malignancy

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  A Radiologist’s Guide to T1 Hyperintensity, T2 Signal, Enhancement, DWI/ADC, Differential Diagnosis, Staging, and Multidisciplinary Management A patient in his 50s presented with persistent nasal obstruction. At first glance, such a symptom can easily be attributed to rhinitis, chronic sinus disease, or a nasal polyp. Yet imaging revealed something fundamentally different: a soft-tissue mass centered in the left nasal cavity with extension toward the left maxillary and ethmoid sinuses. MRI demonstrated heterogeneous signal characteristics, enhancement, and diffusion restriction. Histopathologic examination ultimately established the diagnosis of sinonasal melanoma . This case illustrates an important principle in head and neck imaging: a common symptom does not necessarily indicate a common disease. Sinonasal mucosal melanoma is rare, but it is clinically important because symptoms are often nonspecific and the tumor can extend silently through anatomically complex spaces before ...
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Coin in the Airway: When Hoarseness After “Swallowing a Coin” Is an Airway Emergency

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  How AP and lateral radiographs distinguish airway from esophageal foreign bodies—and why a clinically stable child may still require urgent bronchoscopy. Executive Clinical Summary A coin is usually considered a swallowed foreign body. But the clinical problem changes completely when the object is actually in the airway. A previously healthy boy in his early teens presented after swallowing a coin and continued to experience hoarseness and dysphagia for six hours . His breathing was initially stable, with no stridor or drooling. Chest and neck radiographs, however, demonstrated a round radiopaque foreign body at the level of the subglottic airway . The decisive issue was therefore not simply identifying a metallic object. It was determining where the object was located . In this case, the combination of clinical symptoms and radiographic localization supported the diagnosis of airway foreign body aspiration . The subglottic 25-cent coin was subsequently removed under gene...
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