Juvenile Angiofibroma

28-year-old male presents for long standing nasal obstruction with recurrent epistasis. There is a T1 heterogeneous but predominantly isointense, T2/STIR heterogeneously hyperintense solid and cystic mass with avid enhancement arising from the level of the sphenopalatine foramen with chronic osseous remodeling of the sphenoid bone as well as involving the posteromedial walls of the maxillary antra bilaterally. There is destruction of the posterior nasal septum. Prominent flow voids are noted throughout. Imaging findings are most compatible with a juvenile nasopharyngeal angiofibroma. Juvenile nasopharyngeal angiofinroma are benign but locally agressive tumors occuring almost exclusively in males. Typical age at presentation is adolescence. They are the most common benign nasopharyngeal neoplasm. Treatment is with complete surgical resection, typically in conjunction with preoperative embolization. Involvement of the skull base increases likelihood of tumor recurrence to 50%.