Medscape.com asked me to give them a Case Challenge. I had a good one for them.
 
"A 35-year-old man with a history of adult-onset asthma has had nasal obstruction and smelling loss for 4 months. He also reports postnasal drainage, cough, runny nose, and facial pressure. He has no history of asthma or allergies as a child. He also has no history of previous nasal or paranasal sinus surgery. His symptoms worsen after drinking certain beers and also after using ibuprofen or aspirin."
 
This is a CT scan of his sinuses. White is bone. Black is air. Soft tissue is gray. The sinuses are supposed to contain air (black)!
 
There is not much black, meaning they certainly are filled up. No wonder he couldn't breathe!

Anyway, I was able get him better and he can even drink some beer now.
 
Read more here.

Thomas S. Higgins, MD, MSPH

Father. Husband. Sinus Nerd.