Rare Atypical Radiological Appearance of Nasopharyngeal Angiofibroma: A Diagnostic Difficulty

Abstract

Background: Juvenile angiofibroma is an uncommon, benign and extremely vascular tumor that presents as recurrent severe epistaxis with or without nasal obstruction in adolescent males. It is believed to arise from the posterolateral wall of the nasal cavity at the level of the sphenopalatine foramen. This typically produces characteristic radiological appearance that often renders biopsy unnecessary. However absence of classical radiological features can lead to misdiagnosis and inadvertent life threatening intraoperative complications. Purpose: To highlight the importance of absence of classical radiological presentation of Juvenile nasopharyngeal angiofibroma and add to the curreent knowledge of diagnosis and management of this crucial disease. Result: We came across 15 unique cases of nasopharyngeal angiofibroma with atypical radiological appearance amongst 34 cases over a period of 4 years. All of these cases had absence of nearly all the classical radiological findings. Only one such case was found reported on searching the available English literature on pubmed. Conclusion: With strong clinical suspicion even in the absence of classical radiological signs a differential diagnosis of JNA should be considered when diagnosing any nasal or nasopharyngeal mass owing to the risk of associated life threatening hemorrhage. Furthermore, the absence of classical radiological signs emphasize the need for further research on the site of origin.