Review Question - QID 109461

This patient's age and vascular intranasal mass that occasionally bleeds is concerning for a juvenile nasopharyngeal angiofibroma (JNA). Computerized tomography (CT) scan of the head is performed to arrive at a diagnosis and determine the extent of the lesion.

JNA is a benign, vascular, and hormonally sensitive tumor that primarily occurs in adolescent men. CT scan with contrast enhancement of the lesion can show a non-encapsulated and vascular enhancing soft tissue mass that often widens the pterygomaxillary fissure. CT scan may also show bony erosions of affected adjacent structures. MRI is another appropriate initial imaging modality. Treatment can involve medical therapy such as flutamide and radiotherapy or surgical excision.

Figure A demonstrates a reddish/vascular mass in the nasal mucosa which is concerning for a JNA.

Incorrect Answers:
Answer 1: Biopsy is contraindicated due to the risk of life-threatening bleeding.

Answer 3: Intranasal phenylephrine will not treat the underlying cause of epistaxis, otitis media with effusion, and headache. It is important to diagnose the patient with JNA and ultimately make preparations for surgical resection. Intranasal phenylephrine or topical tranexamic acid could be used to treat epistaxis in general.

Answer 4: Radiotherapy can be used as a treatment modality for this patient's condition. However, imaging must be done first in order to arrive to a diagnosis of JNA prior to beginning treatment.

Answer 5: Surgical resection is the treatment of choice for JNA. However, imaging must be done prior to surgery in order to arrive to a diagnosis and to assess the extent of the disease.

Bullet Summary:
Juvenile nasopharyngeal angiofibroma is a benign and vascular tumor that must be further evaluated with head imaging, such as CT scan or magnetic resonance imaging (MRI).