A 14-year-old boy presents with recurrent epistaxis and nasal obstruction. Contrast-enhanced MRI shows a highly vascular, enhancing nasopharyngeal mass with flow voids extending into the pterygopalatine fossa. The most likely diagnosis is:

• A Nasopharyngeal carcinoma
• B Juvenile nasopharyngeal angiofibroma ✓
• C Hemangioma
• D Rhabdomyosarcoma

Explanation

Juvenile nasopharyngeal angiofibroma occurs exclusively in adolescent males and presents with recurrent epistaxis and nasal obstruction. It is a highly vascular benign tumor that arises near the sphenopalatine foramen, extends into the pterygopalatine fossa, and shows intense enhancement with flow voids on MRI. Nasopharyngeal carcinoma occurs in older adults. Rhabdomyosarcoma is a pediatric tumor but less vascular and more rapidly progressive.

Reference: Brant and Helms Fundamentals of Diagnostic Radiology, 5th ed.

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Written and medically reviewed by the StethoPrep medical team.