History: Teenage boy with epistaxis after contact during a football game
Findings: Axial T1-weighted MR images before and after gadolinium demonstrate an enhancing soft tissue mass filling the nasopharynx and left posterior nasal cavity. The mass is isointense to muscle, demonstrates flow voids, and extends into the into the left pterygopalatine fossa. A lateral view from a left external carotid artery injection shows intense enhancement of this mass, which is fed primarily by branches of the internal maxillary artery.
Diagnosis: Juvenile angiofibroma
Discussion: Juvenile angiofibromas are benign vascular tumors that typically arise in the posterior nasal cavity. The classic history is that of a teenage boy with nasal stuffiness and a nosebleed. These tumors are quite vascular and demonstrate intense enhancement on CT, MRI, and at angiography.
Prominent flow voids within juvenile angiofibromas often give them a ‘salt’ and ‘pepper’ appearance on MRI scans. Extension through the sphenopalatine foramen into the pterygopalatine fossa and occasionally through the pterygopalatine fissure are classic spread patterns for this tumor. Frequently there is associated bony remodeling with anterior displacement of the posterior wall of the maxillary sinus. Treatment is usually preoperative embolization to reduce blood loss followed by surgical resection.
Aunt Minnie’s Pearl’s:
– Juvenile angiofibromas are benign vascular tumors that arise in the posterior nasal cavity and extend through the sphenopalatine foramen into the pterygopalatine fossa.
– These tumors are usually fed by branches of the internal maxillary artery.