Intralesional embolization for a hypervascular lesion of the nasal vestibule.

Abstract

Introduction: Lobular capillary hemangioma is benign vascular lesion commonly encountered in the head and neck region. Although surgical excision remains the standard treatment, management may be challenging in postoperative settings or cosmetically sensitive areas such as the nasal vestibule. We present a case of a hypervascular nasal vestibular lesion with clinical and radiological features consistent with lobular capillary hemangioma, managed with intralesional foam embolization.

Case summary: A 40-year-old woman presented with unilateral nasal obstruction and left alar swelling. MRI showed a hypervascular polypoid lesion filling the left nasal vestibule. Therapeutic angiography revealed vascular blush with venous drainage into the angular and internal jugular veins, without ophthalmic or intracranial involvement. Intralesional polidocanol foam was injected. Mild post-procedural erythema and edema resolved within one week. The lesion progressively regressed, with approximately 50% reduction at one week and nearly two-thirds reduction at one month. At two months, MRI confirmed marked regression and restored nasal patency. At one-year follow-up, serial endoscopic examinations demonstrated stable lesion size without evidence of regrowth.

Discussion: While surgical excision remains the gold standard, intralesional embolization may represent an alternative treatment option in carefully selected superficial vestibular vascular lesions when surgical risks, cosmetic concerns, or patient preference limit operative management.