A newborn has a soft, compressible, pulsatile mass in the left nasal cavity that visibly enlarges and becomes tense when the baby cries. What is the correct next step?
- A Incision biopsy of the mass
- B MRI with contrast to delineate any intracranial connection ✓
- C Fine needle aspiration cytology
- D Endoscopic excision of the mass
Correct answer: B. MRI with contrast to delineate any intracranial connection
Explanation
Enlargement of the mass with crying indicates a positive Furstenberg test, meaning the lesion communicates with the subarachnoid space, as in a meningoencephalocele. Biopsy or attempted excision in this setting can open the sac, producing CSF rhinorrhoea and meningitis. Contrast MRI is mandatory first to map the sac, its neck, and any stalk traversing the cribriform plate or foramen caecum, so that surgical repair can be planned together with neurosurgery.
Reference: Diseases of Ear, Nose and Throat (Dhingra), 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.