Bilateral antrochoanal polyps in a Sudanese patient: a case report

Background: Antrochoanal polyps (ACPs) are pathologically benign nasal swellings. The maxillary sinus is the commonest reported origin. The polyps are usually unilateral and often exit through the progressively widened maxillary sinus ostium to occupy the choana and may reach the nasopharynx. It is a disease of adolescents and young adults who often present with progressive unilateral nasal obstruction. Encountering bilateral antrochoanal polyps is very rare. Case presentation: We report a forty years old male who had progressive bilateral nasal obstruction for 8 years associated with hyposmia and intermittent facial pain and headaches. A nasal mass could be seen on anterior rhinoscopy on both sides, more prominent on the left. Endoscopy revealed bilateral masses hanging down the choanae. Computerized tomography scan of the nose and paranasal sinuses demonstrated bilateral nasal polypi and widening of the maxillary sinus ostia. During endoscopic surgical excision of the lesions, polypi were found to dilate the ostia of both maxillary sinuses. The polypi had antral, nasal, and choanal parts typical of antrochoanal polypi on both sides. The histopathology showed the inflammatory nature characteristic of antrochoanal polyp. Postoperatively, the patient’s symptoms resolved dramatically, and he is on continuous regular scheduled follow-up. Conclusion: Bilateral antrochoanal polyps can present with nasal obstruction and can be misdiagnosed as sinusitis; radiological and endoscopic features are useful to reach specific diagnosis; what is special about our presentation is that it is an addition to the literature of a rare disease (bilateral ACPs), and we are reporting it in an older age rather than the common younger age of presentation in the literature reports, which is an addition to the demographic data.