Introduction: Frontochoanal polyps (FCPs) are rare benign lesions arising from the frontal sinus. They are significantly less common than antrochoanal polyps due to the restrictive anatomy of the frontal drainage pathway. Diagnosis becomes complex when atypical radiological features, such as calcification, mimic aggressive pathologies like Allergic Fungal Sinusitis (AFS). Case Report: A 21-year-old male presented with right-sided forehead swelling and nasal obstruction one year following blunt trauma. Computed Tomography (CT) revealed a mass with internal calcifications, initially favoring a diagnosis of AFS. However, Contrast-Enhanced Magnetic Resonance Imaging (CEMRI) demonstrated T2 hyperintensity, confirming the lesion was an edematous polyp rather than desiccated fungal disease. The calcification was determined to be dystrophic—a secondary change resulting from trauma and chronic inflammation.The patient underwent Functional Endoscopic Sinus Surgery (FESS) adhering to Draf IIA principles to completely excise the polyp and its stalk. Conclusion: Dystrophic calcification in FCPs can simulate fungal sinusitis on CT. This case underscores the critical role of T2-weighted MRI in distinguishing benign inflammatory polyps from AFS, preventing misdiagnosis and ensuring appropriate surgical management.

Mohamed Farook doing final year resident in ENT at Hamdrad Institute of Medical Science and Research, New Delhi