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Open AccessArticle

Parotid Gland Magnetic Resonance Elastography Feasibility Study: Clinical Diagnostic Potential and Future Perspectives as a Radiological Palpation Method

by Merve Solak, Esat Kaba, Mehmet Beyazal, Metin Çeliker and Fatma Beyazal Çeliker

Diagnostics 2025, 15(18), 2351; https://doi.org/10.3390/diagnostics15182351 - 16 Sep 2025

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Abstract

Background/Objectives: Magnetic resonance elastography (MRE) is a noninvasive imaging technique that quantitatively characterizes tissue mechanical properties. This study aimed to establish and validate a feasible parotid MRE protocol using 3T MRI, with potential relevance for oral and maxillofacial surgery (OMFS) and otorhinolaryngology practice. [...] Read more.

Background/Objectives: Magnetic resonance elastography (MRE) is a noninvasive imaging technique that quantitatively characterizes tissue mechanical properties. This study aimed to establish and validate a feasible parotid MRE protocol using 3T MRI, with potential relevance for oral and maxillofacial surgery (OMFS) and otorhinolaryngology practice. Methods: This study included 21 healthy volunteers (18 women, 3 men; mean age, 49 years) examined between January and May 2024. MRE was performed using a 3.0 Tesla MRI system (Discovery MR750w, GE Healthcare, Waukesha, WI, USA) with a passive driver positioned over the parotid gland in a 16-channel head/neck coil. Two radiologists independently analyzed axial magnitude images drawing regions of interest (ROIs) encompassing the entire gland while excluding intraparotid lymph nodes and vascular structures. Mean and maximum stiffness values (kPa) were recorded for each gland. Interobserver agreement was assessed using intraclass correlation coefficients (ICCs) and Bland–Altman analysis. Results: Mean stiffness was 1.209 ± 0.240 kPa (Radiologist 1) and 1.146 ± 0.233 kPa (Radiologist 2); maximum stiffness was 1.595 ± 0.532 kPa and 1.563 ± 0.528 kPa, respectively. ICCs were 0.638 for mean stiffness and 0.918 for maximum stiffness, indicating moderate-to-excellent agreement. Conclusions: MRE is a technically feasible and reproducible method for evaluating parotid stiffness using standard imaging infrastructure. This feasibility study in healthy volunteers provides normative stiffness values for the parotid gland and supports MRE as a potential tool for “radiological palpation” to aid in the differentiation of salivary gland lesions and post-treatment assessment in OMFS and otorhinolaryngology practice. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Head and Neck Disease)

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14 pages, 902 KB

Open AccessArticle

Prognostic Value of the CALLY Index in Hypopharyngeal Cancer Treated with Definitive Chemoradiotherapy: A Retrospective Cohort Study

by Hasan Oguz Cetinayak, Barbaros Aydin, Volkan Semiz, Ece Atac Kutlu, Umut Basan and Rahmi Atıl Aksoy

Diagnostics 2025, 15(17), 2237; https://doi.org/10.3390/diagnostics15172237 - 3 Sep 2025

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Abstract

Background: The hypopharyngeal region is among the most aggressive sites of head and neck squamous cell carcinoma, often presenting at an advanced stage with poor survival outcomes. However, there are only a limited number of biomarkers available to predict the prognosis of this [...] Read more.

Background: The hypopharyngeal region is among the most aggressive sites of head and neck squamous cell carcinoma, often presenting at an advanced stage with poor survival outcomes. However, there are only a limited number of biomarkers available to predict the prognosis of this aggressive disease. Recent interest has focused on immunonutritional biomarkers that may improve prognostication. The C-reactive protein–albumin–lymphocyte (CALLY) index has emerged as a composite biomarker integrating systemic inflammation, nutritional status, and immune competence. However, its clinical relevance in hypopharyngeal cancer has not been established. Methods: This retrospective, single-center study included patients with histologically confirmed hypopharyngeal squamous cell carcinoma treated with definitive chemoradiotherapy between 2010 and 2024. Patients were excluded from the study if they had incomplete laboratory data, had a concomitant malignancy, were undergoing induction chemotherapy, or had diseases affecting inflammatory and immunological markers. The CALLY index was calculated using pre-treatment laboratory values. Receiver operating characteristic (ROC) analysis determined the optimal cut-off value for overall survival (OS). Kaplan–Meier survival estimates and Cox regression analyses were used to assess associations between the CALLY index and progression-free survival (PFS), local recurrence-free survival (LRFS), and OS. Results: A total of 71 patients were included. The optimal CALLY cut-off was 1.47 (AUC = 0.70, p = 0.006). Patients with a CALLY index ≥ 1.47 had significantly improved median PFS (37 vs. 9 months, p = 0.003), LRFS (39 vs. 9 months, p = 0.002), and OS (61 vs. 11 months, p = 0.002). In multivariate analysis, the CALLY index and T stage remained independent prognostic factors of all three survival outcomes. Conclusions: The pretreatment CALLY index is a practical, accessible biomarker that independently predicts survival in hypopharyngeal cancer. Its integration into clinical practice may enhance risk stratification and guide individualized management strategies. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Head and Neck Disease)

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12 pages, 588 KB

Open AccessArticle

Factors Affecting Thyroid Volume in Children Aged 4 to 18 Years

by Nevena Folić, Marko Folić, Miloš N. Milosavljević, Ana V. Pejčić, Slobodan Janković, Maja Vulović, Milos Stepovic, Isidora Mihajlović and Jovana Milosavljević

Diagnostics 2025, 15(15), 1980; https://doi.org/10.3390/diagnostics15151980 - 7 Aug 2025

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Abstract

Background and Objectives: Ultrasound measurement of thyroid volume is not routinely performed in children without suspected thyroid disorders. However, pediatricians must be aware of the normal thyroid volume values in children in order to recognize and treat thyroid disorders in children on time. [...] Read more.

Background and Objectives: Ultrasound measurement of thyroid volume is not routinely performed in children without suspected thyroid disorders. However, pediatricians must be aware of the normal thyroid volume values in children in order to recognize and treat thyroid disorders in children on time. Therefore, this study aimed to explore factors that influence thyroid volume in children aged 4 to 18 years and to provide descriptive data on thyroid volume across this age range. Materials and Methods: This was a prospective, non-interventional cross-sectional study conducted on a population of children aged 4 to 18 years without confirmed thyroid disorders. We used validated formulas for calculating thyroid volume that integrate the linear dimensions of this organ, such as length, width, and depth, as well as the appropriate correction factor. The Spearman or Pearson correlation coefficient was calculated to assess the relationship between total thyroid volume and various continuous variables, while multiple linear regression analysis was used to evaluate the effect of potential predictors on the total thyroid volume. Results: The study included 100 children, predominantly girls (75.0%). Significant positive correlations with thyroid volume were found for age, height, weight, body mass index (BMI), body surface area, serum creatinine, birthweight, and number of comorbidities, while calcitonin was negatively correlated with children’s thyroid volume. We identified age, BMI, and serum creatinine as significant independent positive predictors of thyroid volume in children. Conclusions: Age, BMI, and serum creatinine emerged as significant independent positive predictors of thyroid volume and should be considered when interpreting pediatric thyroid ultrasound measurements. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Head and Neck Disease)

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16 pages, 2584 KB

Open AccessArticle

Radiologic Predictors of Disease Recurrence in Nasopharyngeal Carcinoma: A Retrospective Evaluation of MRI and ¹⁸F-FDG-PET/CT Parameters

by Banu Karaalioğlu, Tansel Çakır, Ömer Yazıcı, Mustafa S. Tekin and Ebru Karcı

Diagnostics 2025, 15(13), 1646; https://doi.org/10.3390/diagnostics15131646 - 27 Jun 2025

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Abstract

Background/Objectives: NPC is a radiosensitive malignancy with high recurrence rates despite therapeutic advances. This study aimed to identify radiologic and metabolic predictors of recurrence in newly diagnosed NPC by integrating MRI and ¹⁸F-FDG PET/CT parameters. Methods: Fifty-two patients with biopsy-proven, previously untreated [...] Read more.

Background/Objectives: NPC is a radiosensitive malignancy with high recurrence rates despite therapeutic advances. This study aimed to identify radiologic and metabolic predictors of recurrence in newly diagnosed NPC by integrating MRI and ¹⁸F-FDG PET/CT parameters. Methods: Fifty-two patients with biopsy-proven, previously untreated NPC who underwent pre-treatment MRI and ¹⁸F-FDG PET/CT were retrospectively analyzed. Local tumor features, nodal status, and response patterns were evaluated using MRI and PET/CT-derived metrics: SUVmax, SUVmean, SUVpeak, MTV, and TLG. The post-treatment MRI response was categorized into six patterns. Univariate and multivariate analyses were performed to identify independent predictors. Results: Recurrence occurred in 27% of patients. Based on the multivariate analysis, PNI, extensive PPS invasion, GTV, and metastatic LN count were identified as independent predictors of recurrence (PNI: OR = 1.60, p = 0.029; PPS: OR = 1.23, p = 0.027; GTV: OR = 1.08, p = 0.042; LN count: OR = 1.20, p = 0.031). PNI and PPS invasion were significantly associated with local failure (HR = 8.21, p = 0.008 and HR = 3.52, p = 0.043, respectively). GTV was independently associated with an increased risk of local (HR = 1.14, p = 0.021) and distant recurrence (HR = 1.19, p = 0.024). The presence of metastatic disease at diagnosis (HR = 6.27, p = 0.027) and a higher LN count (HR = 1.17, p = 0.028) were also linked to distant failure. Conclusions: Imaging-derived predictors including GTV, PNI, LN burden, and MRI-based response patterns demonstrate prognostic value for disease recurrence in NPC and may guide risk-adapted treatment strategies. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Head and Neck Disease)

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14 pages, 1462 KB

Open AccessArticle

Analysis of Selected Small Proline-Rich Proteins in Tissue Homogenates from Samples of Head and Neck Squamous Cell Carcinoma

by Dariusz Nałęcz, Agata Świętek, Dorota Hudy, Zofia Złotopolska, Jakub Opyrchał, David Aebisher and Joanna Katarzyna Strzelczyk

Diagnostics 2025, 15(13), 1633; https://doi.org/10.3390/diagnostics15131633 - 26 Jun 2025

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Abstract

Background/Objectives: Head and neck squamous cell carcinoma (HNSCC) ranks sixth in the world in terms of incidence. Small proline-rich proteins (SPRRs) are precursors of the keratinocyte envelope and act as substrates of transglutaminase. A change in SPRR expression is characteristic in a [...] Read more.

Background/Objectives: Head and neck squamous cell carcinoma (HNSCC) ranks sixth in the world in terms of incidence. Small proline-rich proteins (SPRRs) are precursors of the keratinocyte envelope and act as substrates of transglutaminase. A change in SPRR expression is characteristic in a few types of cancer. Our aim was to determine the concentration of SPRR1A and SPRR2A in tumours samples obtained from 61 patients with HNSCC (OSCC, OPSCC, LSCC, HPSCC, NCSCC, and SSCC). Also, we aimed to determine the relationship between protein concentration and other clinical and/or demographic variables. Methods: An ELISA test was used to determine the concentrations of SPRR in the tumour tissue homogenates. Results: In margin samples, we found a statistically significant association between SPRR1A levels and nodal status (N) and between SPRR1A levels in tumours and margins with G2 histological grade. When we analysed the effect of tobacco and alcohol habits, we found a statistically significant difference between the SPRR1A and SPRR2A amount in smokers and non-smokers in margin samples. Also, we found a statistically significant difference between the SPRR1A and SPRR2A levels in tumour and margin samples obtained from patients that either abstain and occasionally or regularly consume alcohol. Furthermore, we found in tumour and margin samples from patients with concomitant diseases an association between SPRR1A and SPRR2A levels. Our results showed altered concentrations of SPRR1A at margins, depending on HPV status. Conclusions: These results suggest that differences in SPRR proteins are determined by disease status and unhealthy behaviours, which, in a wider perspective, can influence carcinogenesis. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Head and Neck Disease)

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12 pages, 3055 KB

Open AccessArticle

Diagnostic Performance of Magnetic Resonance Sequences in Staging Lymph Node Involvement and Extranodal Extension in Head and Neck Squamous Cell Carcinoma

by Giovanni Lorusso, Nicola Maggialetti, Francesca Laugello, Annalisa Garofalo, Ilaria Villanova, Sara Greco, Chiara Morelli, Pasquale Pignataro, Nicola Maria Lucarelli and Amato Antonio Stabile Ianora

Diagnostics 2025, 15(10), 1251; https://doi.org/10.3390/diagnostics15101251 - 15 May 2025

Cited by 1 | Viewed by 854

Abstract

Objectives: This study aimed to evaluate the diagnostic performance of various MRI sequences in detecting nodal metastasis (N+) and extranodal extension (ENE+) in patients with head and neck squamous cell carcinoma (HNSCC). Methods: A retrospective analysis was conducted on 42 patients with [...] Read more.

Objectives: This study aimed to evaluate the diagnostic performance of various MRI sequences in detecting nodal metastasis (N+) and extranodal extension (ENE+) in patients with head and neck squamous cell carcinoma (HNSCC). Methods: A retrospective analysis was conducted on 42 patients with HNSCC who underwent preoperative MRI and subsequent surgical lymph node dissection between June 2021 and December 2023. Lymph node MRI features were evaluated on five different MRI sequences. For each rN+ case, the presence of radiological extranodal extension (rENE+) was assessed independently in every MRI sequence by analyzing three characteristics. ENE was deemed positive if at least one of three criteria considered was present. Results: All of the MRI sequences demonstrated slightly high accuracy (~76%) for detecting N+, with T1WI, STIR, and CE THRIVE showing comparable sensitivities (60–65%). The STIR sequence exhibited the highest sensitivity (75%) and nearly the highest accuracy (91%) for detecting ENE+. Capsular irregularity and necrosis showed high specificity across sequences, while the loss of fatty hilum and nodal size had lower performance. Conclusions: Tailoring MRI protocols to leverage the strengths of specific sequences can significantly improve the diagnostic accuracy, aiding in better patient management and treatment outcomes. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Head and Neck Disease)

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12 pages, 2311 KB

Open AccessArticle

Intraoperative Management of Parathyroid Glands and Long-Term Outcome of Parathyroid Function Following Total Thyroidectomy

by Feng-Yu Chiang, Kang Dae Lee, Kyung Tae, Kwang Yoon Jung, Chih-Chun Wang, Tzer-Zen Hwang, Che-Wei Wu, Shih-Wei Wang, Yu-Chen Shih and Tzu-Yen Huang

Diagnostics 2025, 15(5), 593; https://doi.org/10.3390/diagnostics15050593 - 28 Feb 2025

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Abstract

Background/Objectives: In situ preservation is the primary strategy to preserve parathyroid gland (PG) function during thyroid surgery, while autotransplantation is used when inadvertent removal or devascularization occurs. Deciding on the optimal approach intraoperatively for exposed PGs remains challenging. This study evaluates intraoperative PG [...] Read more.

Background/Objectives: In situ preservation is the primary strategy to preserve parathyroid gland (PG) function during thyroid surgery, while autotransplantation is used when inadvertent removal or devascularization occurs. Deciding on the optimal approach intraoperatively for exposed PGs remains challenging. This study evaluates intraoperative PG management strategies and long-term outcomes of PG function following total thyroidectomy. Methods: This retrospective study included 543 patients undergoing primary total thyroidectomy, excluding those with comorbid parathyroid disease. A stabbing test assessed the vascular supply of exposed PGs. PGs with fresh blood oozing after the test were preserved in situ; otherwise, they were autotransplanted. Intact parathyroid hormone (iPTH) and ionized calcium (iCa) were measured preoperatively and on postoperative day 1 (PO-1D), and during follow-up. Permanent hypoparathyroidism (PHPS) was defined as iPTH < 15 pg/mL, iCa < 4.2 mg/dL, or continued need for calcitriol or calcium supplementation after a postoperative period of 12 months (PO-12M). The PHPS rate was compared with the corresponding intraoperative PG status. Results: A total of 528 patients were enrolled in this study. At PO-1D, 434 patients (82.2%) had iPTH ≥ 15 pg/mL, 65 (12.3%) had iPTH between 4 and 15 pg/mL, and 29 (5.5%) had iPTH < 4 pg/mL. At PO-12M, 527 patients (99.81%) had iPTH ≥ 15 pg/mL, 1 (0.19%) had iPTH between 4 and 15 pg/mL, and none had iPTH < 4 pg/mL. Five patients (0.95%) were in PHPS after PO-12M. Among the 462 patients with at least one viable PG preserved in situ, the PHPS rate was 0.2%, compared to 6.1% (66 patients) for those without a viable PG preserved in situ (p < 0.001). Conclusions: Permanent hypoparathyroidism is rare when at least one viable PG is preserved in situ during total thyroidectomy. The stabbing test is a simple, useful, and cost-effective method to assess the vascular supply of exposed PGs, providing surgeons with essential information for intraoperative PG management. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Head and Neck Disease)

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12 pages, 1344 KB

Open AccessArticle

Intraoperative Facial Nerve Monitoring during Parotidectomy: The Current Practices and Patterns of the Korean Society of Head and Neck Surgery (KSHNS)

by Dongbin Ahn, Ji Hye Kwak, Geun-Jeon Kim, Heejin Kim, Dong Won Lee and Kwang Jae Cho

Diagnostics 2024, 14(20), 2277; https://doi.org/10.3390/diagnostics14202277 - 13 Oct 2024

Cited by 1 | Viewed by 2473

Abstract

Objectives: This study aimed to evaluate the current practices and trends of intraoperative facial nerve (FN) monitoring (IOFNM) during parotidectomy. Methods: A questionnaire containing 33 questions collecting information on the usage, indications, settings, techniques, loss of signal (LOS) management, anesthesiologist cooperation, and perception [...] Read more.

Objectives: This study aimed to evaluate the current practices and trends of intraoperative facial nerve (FN) monitoring (IOFNM) during parotidectomy. Methods: A questionnaire containing 33 questions collecting information on the usage, indications, settings, techniques, loss of signal (LOS) management, anesthesiologist cooperation, and perception of usefulness of IOFNM was distributed among 348 members of the Korean Society of Head and Neck Surgery (KSHNS) via a dedicated website. Results: The response rate was approximately 25.6%, and 97% of the respondents reported using IOFNM selectively or routinely during parotidectomy. IOFNM usage decreased as the surgeon’s level of experience increased (p = 0.089), from 100% in those with less than 5 years of experience to 75% in those with 20 or more years. Approximately 95% of respondents reported that the initial event threshold for electromyography activity used was 50–149 μV. Moreover, 52.4% of respondents performed neural mapping of the FN before visual identification. Initial management of LOS in visually intact FNs included checking the IOFNM system (75.3%), confirmation of muscle relaxant dosage (75.3%), and facial twitch identification (58.8%). Further management included proceeding with surgery regardless of persistent LOS (81.2%) and steroid administration sometimes or all of the time (72.9%). Overall, 98.8% of respondents found IOFNM beneficial for safe execution of parotidectomy. Conclusions: The majority of KSHNS surgeons used IOFNM during parotidectomy, although the clinical implementation of the procedure and LOS management varied between practitioners. This could be attributed to the lack of standardized protocols for IOFNM, emphasizing the need for the development of evidence-based consensus guidelines for all institutions. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Head and Neck Disease)

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19 pages, 3179 KB

Open AccessArticle

Enhancing Predictive Accuracy for Recurrence-Free Survival in Head and Neck Tumor: A Comparative Study of Weighted Fusion Radiomic Analysis

by Mohammed A. Mahdi, Shahanawaj Ahamad, Sawsan A. Saad, Alaa Dafhalla, Alawi Alqushaibi and Rizwan Qureshi

Diagnostics 2024, 14(18), 2038; https://doi.org/10.3390/diagnostics14182038 - 14 Sep 2024

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Abstract

Despite advancements in oncology, predicting recurrence-free survival (RFS) in head and neck (H&N) cancer remains challenging due to the heterogeneity of tumor biology and treatment responses. This study aims to address the research gap in the prognostic efficacy of traditional clinical predictors versus [...] Read more.

Despite advancements in oncology, predicting recurrence-free survival (RFS) in head and neck (H&N) cancer remains challenging due to the heterogeneity of tumor biology and treatment responses. This study aims to address the research gap in the prognostic efficacy of traditional clinical predictors versus advanced radiomics features and to explore the potential of weighted fusion techniques for enhancing RFS prediction. We utilized clinical data, radiomic features from CT and PET scans, and various weighted fusion algorithms to stratify patients into low- and high-risk groups for RFS. The predictive performance of each model was evaluated using Kaplan–Meier survival analysis, and the significance of differences in RFS rates was assessed using confidence interval (CI) tests. The weighted fusion model with a 90% emphasis on PET features significantly outperformed individual modalities, yielding the highest C-index. Additionally, the incorporation of contextual information by varying peritumoral radii did not substantially improve prediction accuracy. While the clinical model and the radiomics model, individually, did not achieve statistical significance in survival differentiation, the combined feature set showed improved performance. The integration of radiomic features with clinical data through weighted fusion algorithms enhances the predictive accuracy of RFS outcomes in head and neck cancer. Our findings suggest that the utilization of multi-modal data helps in developing more reliable predictive models and underscore the potential of PET imaging in refining prognostic assessments. This study propels the discussion forward, indicating a pivotal step toward the adoption of precision medicine in cancer care. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Head and Neck Disease)

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15 pages, 44622 KB

Open AccessArticle

CD3 and CD20 Expressions and Infiltrating Patterns in Salivary Gland Tumors

by Rukhsar R. Hussein and Balkees T. Garib

Diagnostics 2024, 14(9), 959; https://doi.org/10.3390/diagnostics14090959 - 3 May 2024

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Abstract

Tumor-infiltrating lymphocytes (TILs) represent a subset of immunological constituents within the tumor microenvironment that can influence cancer growth. We retrospectively evaluate the density and pattern of CD3 and CD20 expression in salivary gland tumors and their relation to clinical pathologic parameters. A total [...] Read more.

Tumor-infiltrating lymphocytes (TILs) represent a subset of immunological constituents within the tumor microenvironment that can influence cancer growth. We retrospectively evaluate the density and pattern of CD3 and CD20 expression in salivary gland tumors and their relation to clinical pathologic parameters. A total of 44 formalin-fixed paraffin-embedded blocks of salivary gland tumors were included. These tumors were stained immunohistochemically with CD3 and CD20. The chi-square test was used to relate immune scoring, intensity, and clinical pathological parameters to different salivary tumors. p-value < 0.05 was considered statistically significant. The intra-tumoral CD3 infiltrating count was high and diffused in (71.4%) of pleomorphic adenomas (PAs) followed by mucoepidermoid carcinomas (MECs) (66.7%). At the same time, adenoid cystic carcinomas (AdCCs) exhibited significantly low infiltration (71.4%) (p = 0.046). The three types of tumors exhibited high tumor-infiltrating counts diffused in peripheral areas with significant differences between malignant tumors (p = 0.047). The intra-tumoral CD20 infiltrating count significantly differed among the tumors (p = 0.002); it was low in all PAs and AdCCs, while MECs showed an equal percentage of expression. However, in the peripheral area, PAs and MECs exhibited significantly (p = 0.007) high infiltrating counts (69.2% and 84.6), and the lowest infiltrating count was predominantly found for AdCCs. The two markers had a significant positive correlation between the mean of CD3 in the intra-tumoral and peripheral regions and CD20 in the peripheral zone across the total samples. In conclusion, the density of CD3 expression is notably higher than CD20 across tumor types. PAs and MECs showed high-density scores, while AdCCs were characterized by low scores. TIL expression was found to be significantly associated with patients’ outcomes in the intra-tumoral area. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Head and Neck Disease)

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Open AccessCase Report

An Unveiling of the Misdiagnosis of Granulomatosis with Polyangiitis as Acute Sinusitis: A Case Report

by Qi Wang, Yi Ling, Yangyiyi Huang, Lijing Zhao, Zhewei Lou, Guokang Fan and Jing Xue

Diagnostics 2025, 15(17), 2218; https://doi.org/10.3390/diagnostics15172218 - 1 Sep 2025

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Abstract

Background and Clinical Significance: Granulomatosis with polyangiitis (GPA), an immune-mediated systemic small-vessel vasculitis affecting the upper/lower respiratory tracts and kidneys, frequently presents with non-specific nasal symptoms that lead to misdiagnosis. Case Presentation: We report a case of a 55-year-old female with [...] Read more.

Background and Clinical Significance: Granulomatosis with polyangiitis (GPA), an immune-mediated systemic small-vessel vasculitis affecting the upper/lower respiratory tracts and kidneys, frequently presents with non-specific nasal symptoms that lead to misdiagnosis. Case Presentation: We report a case of a 55-year-old female with GPA complicated by Bartter syndrome. She presented with one month of left nasal congestion, rhinorrhea, epistaxis, and headache. Initial diagnosis was acute sinusitis. Computed tomography (CT) revealed left maxillary and ethmoid sinus inflammation with bone destruction, while metagenomic next-generation sequencing (mNGS) suggested conventional bacterial infection. Postoperative pathology demonstrated chronic mucosal inflammation with lymphoid tissue hyperplasia. GPA was ultimately diagnosed based on PR3-ANCA seropositivity and chest CT findings of cavitary pulmonary nodules. Postoperatively, severe hypokalemia and hypomagnesemia secondary to Bartter syndrome emerged. Following electrolyte correction, induction therapy with glucocorticoids and cyclophosphamide was initiated. Conclusions: This case underscores that GPA’s head and neck manifestations are frequently misdiagnosed as infections or malignancies. Early diagnosis requires vigilance for GPA ‘red flags’, such as refractory nasal symptoms to conventional therapy (e.g., bloody rhinorrhea), characteristic CT findings (e.g., sinus opacification without ostiomeatal complex obstruction), and nasal endoscopy findings (e.g., ulcers/crusting). Otolaryngologists play a pivotal role in recognizing early disease onset and initiating timely treatment. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Head and Neck Disease)

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