Differential Diagnosis for a Small Volume Enhancing Soft Tissue in the Right Pterygopalatine Fossa
- Single Most Likely Diagnosis
- Invasive fungal sinusitis: This is a likely diagnosis given the concern for invasive sinus disease and the location in the pterygopalatine fossa. The preserved mucosal enhancement and lack of gross necrosis are consistent with early invasive fungal disease.
- Other Likely Diagnoses
- Squamous cell carcinoma: This is a common malignancy in the head and neck region and can present as an enhancing soft tissue mass in the pterygopalatine fossa.
- Sinusitis with extension into the pterygopalatine fossa: Bacterial or viral sinusitis can extend into the pterygopalatine fossa, causing enhancement and swelling.
- Lymphoma: Lymphoma can present as an enhancing soft tissue mass in the pterygopalatine fossa, although it is less common than other diagnoses.
- Do Not Miss Diagnoses
- Malignant otolaryngologic tumors (e.g., adenoid cystic carcinoma, mucoepidermoid carcinoma): These tumors can be aggressive and have a high mortality rate if not diagnosed and treated promptly.
- Angiofibroma: Although typically seen in younger males, angiofibroma can present as an enhancing mass in the pterygopalatine fossa and can be highly vascular, making it a critical diagnosis not to miss.
- Rare Diagnoses
- Neurogenic tumors (e.g., schwannoma, neurofibroma): These tumors can arise in the pterygopalatine fossa, although they are rare in this location.
- Vascular malformations or aneurysms: Although rare, vascular malformations or aneurysms can present as an enhancing mass in the pterygopalatine fossa.
- Metastatic disease: Metastases to the pterygopalatine fossa are rare, but can occur, especially from primary tumors such as breast, lung, or prostate cancer.