Juvenile nasopharyngeal angiofibroma is a highly vascular tumor that occurs exclusively in adolescent males, though genetic testing may reveal cases in females with mosaicism. Imaging with sinus CT, CE MRI, and catheter angiography is used to identify the origin at the sphenopalatine foramen and extensions into surrounding areas like the nasal cavity, pterygopalatine fossa, and orbit. CE MRI best demonstrates the tumor's flow voids and avid enhancement, while catheter angiography can identify enlarged feeding vessels before potential preoperative embolization to reduce blood loss during complete surgical resection of all extensions.

1. Juvenile nasopharyngeal
angiofibroma
Imaging findings

2. 14-17 males exclusively
if found in females, genetic testing
may reveal mosaicism

3. ! no biopsy
highly vascular tumor

4. imaging tools
sinus CT and CE MRI
and catheter angiography

5. bone CT
origin at sphenopalatine foramen, posterior to maxillary sinus
posterior wall of maxillary sinus bowed anteriorly
can extend to
nasal cavity, posterosuperior – actually begins in nasal cavity
pterygopalatine fossa
nasopharynx
oropharnyx
inferior orbital fissure
maxillary, ethmoid sinuses
infratemporal fossa
middle cranial fossa via vidian canal, foramen rotundum

6. bone CT
bone expansion +/- destruction
look for skull base erosion

7. CE MRI
flow voids
avid enhancement

8. CE MRI
coronal T1+C FS for cavernous sinus, sphenoid sinus, skull base
MRA
enlarged ipsilateral ECA and internal maxillary
can be supplied from ICA and contralateral ECA as well

9. Catheter angiography
preop embolization + complete surgical resection
radiotherapy for intracranial disease
MRA

10. Remember
hypervascular mass in typical location
in adolescent male with epistaxis
consider other diagnosis in female patients

11. Remember
!be sure to identify all tumor extensions
for complete surgical resection,
including orbit and middle cranial fossa