A 15 year old male presents with severe epistaxis from the back of his nose. There is nasal obstruction, nasal drainage, serous otitis media, and diminished hearing on exam. A gadolinium enhanced T1 weighted fat saturated MRI is shown above. Although locally aggressive, histology shows this mass to be benign.Challenge: What is it?
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The Nose Knows
“Primary Care Otolaryngology” states that bleeding from the back of the nose in an adolescent male strongly suggests juvenile nasopharyngeal angiofibroma, a benign localized neoplasm usually arising in the lateral nasopharynx and hormonally sensitive. Biopsy is not recommended because of risk of severe bleeding.
Source: “Primary Care Otolaryngology” (AAO-HNSF); UpToDate; www.radpod.org (original photo courtesy of Dr. Laughlin Dawes).
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