A 16-year-old male with a history of recurrent epistaxis, initially started on the left side and then becoming bilateral, progressed to being every three days with clots and congestion. In the past few weeks, he had headaches and weight loss.

The CT shows a large mass lesion occupying the nasopharynx, sphenoid sinus as well as the posterior ethmoid air cells with multilateral expansion, which indicates a large juvenile angiofibroma. The subsequent MRI demonstrated further typical features, including avid enhancement and flow voids.

The patient underwent embolization of the tumor and endoscopic resection 1 day later, the histology confirmed the diagnosis.

Juvenile nasopharyngeal angiofibroma is an uncommon locally destructive benign tumor with high risk of recurrence. There is a study showing that endoscopic approach is associated with a lower recurrence rate compared with open surgery.

This case shows the classic history and treatment approaches of JNA and points out the importance of interdisciplinary collaboration for the best management.

Case contributed by Dr Lucia Carpineta, Assistant Professor in Pediatric Radiology at McGill University.