Presentation
Recurrent epistaxis and nasal obstruction.
Patient Data
A large soft tissue mass is centered upon the nasopharynx and right pterygopalatine fossa, with the widening of the pterygopalatine fissure. The mass measured 5.3 x 5.8 x 4.8 cm in AP, TS, and LS diameters, respectively. It displays hypointense SI in T1 WI and isointense SI in T2 WI, while postcontrast-enhanced (gadolinium) T1-W MRI images reveal marked homogenous enhancement.
The mass extends anteriorly through the posterior nasal choana, reaching the posterior nasal cavity, with extension to the right maxillary and ethmoidal sinuses.
The mass extends laterally towards the infratemporal fossa and, to a lesser extent, orbit, superiorly abutting the temporal horn of the brain and posteriorly through the hypothalamus, sellar, and right para-sellar region, engulfing the cavernous sinus as well as encasing the internal carotid arteries more at the right side, yet still evident by its signal void.
It extends to the optic chiasma posteriorly, inferiorly eroding the clivus, and extending downward to the level of the second cervical vertebra.
Case Discussion
The case was pathologically proven to be a juvenile nasopharyngeal angiofibroma. This tumor corresponds to a benign but locally aggressive vascular tumor, as shown in this case.
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