title: Spontaneous Nasal Septal Abscess Presenting as a Soft Tissue Mass in a Child.
abstract: BACKGROUND
  Nasal septal abscess (NSA) is a rare condition most commonly seen as a complication of nasal trauma. The diagnosis of NSA requires emergent treatment, because delayed management can result in significant morbidity. Typically, NSA presents as a purulent collection that can be managed with drainage, either surgically or at bedside.
  
  
  METHODS
  We report an unusual presentation of a spontaneous NSA in a 7-year-old boy as a solid nasal mass eroding the nasal septum. The solid, tumor-like nature of the mass necessitated intervention beyond drainage and was ultimately excised. Imaging initiated in the emergency department revealed a partially cystic mass and erosion of the septum, which was key to the diagnosis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Given the ease with which a diagnosis of NSA may be missed and the need for urgent management upon diagnosis of a NSA, we aim to highlight the clinical, radiologic, and histopathologic aspects that aid in diagnosis of NSA. Imaging, obtaining culture results, and initiation of antibiotics are paramount in management. In addition, NSAs may also necessitate bedside drainage given their emergent nature.
authors.affiliation: Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Yi
authors.initials: Y
authors.lastname: Cai
authors.affiliation: Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York.
authors.forename: Anjali
authors.initials: A
authors.lastname: Saqi
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Joseph
authors.initials: J
authors.lastname: Haddad
mesh_terms: D000038:Abscess / Q000401:mortality / Q000601:surgery*; D000658:Amoxicillin / Q000494:pharmacology / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D002648:Child; D004636:Emergency Service, Hospital / Q000458:organization & administration; D004844:Epistaxis / Q000209:etiology; D005334:Fever / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000472:pathogenicity; D009300:Nasal Septum / Q000002:abnormalities* / Q000000981:diagnostic imaging; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D010878:Piperacillin / Q000494:pharmacology / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D012422:Rupture, Spontaneous / Q000209:etiology*; D014057:Tomography, X-Ray Computed / Q000379:methods; D014640:Vancomycin / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D000077725:Piperacillin, Tazobactam Drug Combination; D014640:Vancomycin; D000658:Amoxicillin; D010397:Penicillanic Acid; D010878:Piperacillin
keywords: nasal septal abscess; pediatric