This is a classical presentation of juvenile nasopharyngeal angiofibroma. This is a histologically benign lesion with very aggressive local behavior.

It is almost exclusively encountered in adolescent males ¹. The most common presenting symptom is painless nasal obstruction or epistaxis; however, other symptoms may develop depending on the size and extent of the tumor mass. 

The lesion tends to spread via the pterygopalatine fossa and osseous destruction is common. Orbital and intracranial extension can be seen at presentation which complicates treatment.

These lesions are highly vascular and biopsy is contraindicated due to the risk of hemorrhage. CT or MRI have important roles in assessing the tumor mass and extension and assist with treatment planning. DSA elegantly demonstrates the vascular supply and allows pre-operative embolization of the feeder vessels. Post-embolization surgical resection is the treatment of choice ².