A 14-year-old boy presents with progressively worsening nasal obstruction, epistaxis, and right cheek fullness. Examination shows a vascular mass in the nasopharynx that bleeds on probing. Contrast CT shows intense homogeneous enhancement with 'salt and pepper' pattern. What is the imaging finding called, and what does it represent?
- A 'Salt and pepper' pattern represents flow voids from feeding vessels and areas of hemorrhage in JNA ✓
- B 'Salt and pepper' is pathognomonic of olfactory neuroblastoma
- C 'Salt and pepper' represents calcifications in an angiofibroma
- D 'Salt and pepper' indicates malignant transformation to fibrosarcoma
Correct answer: A. 'Salt and pepper' pattern represents flow voids from feeding vessels and areas of hemorrhage in JNA
Explanation
The 'salt and pepper' pattern on MRI of JNA (Juvenile Nasopharyngeal Angiofibroma) represents flow voids from high-flow feeding vessels (the 'pepper' — dark areas on T1WI due to signal loss from rapid blood flow) and areas of intratumoral hemorrhage or fat (the 'salt' — bright T1 areas). This is a characteristic MRI finding of JNA. Holman-Miller sign (anterior bowing of the posterior wall of the maxillary antrum on CT) is another classic feature.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.