Juvenile angiofibromasBy mahyarHistory: A 17 Y / M with difficulty breathing through the nose Findings:
:: X-Ray 1 ::Anteroposterior digital subtraction external carotid arteriogram shows dense hypervascular tumor blush within a large JAF fed by the internal maxillary artery
:: CT 1 ::Axial non Contrast CT
:: CT 2 ::coronal non contrast CT
:: CT 3 ::Axial CT with contrast
:: X-Ray 2 ::DSA ; Selective ICA Discussion: Juvenile angiofibroma is a benign nonencapsulated fibrovascular tumor that usually originates from the superolateral aspect of the choana, but may also arise more medially, near the vomer, from the pharyngeal roof or adjacent pterygoid plates. It extends submucosally into the adjacent open spaces and passages The sphenopalatine foramen and pterygopalatine fossa are almost always involved. Authors consider MRI superior to CT in delineating the margins of tumor and in revealing tumor vascularity. Anterior bowing of the posterior wall of the maxillary sinus, the "antral bowing" sign, can be seen in most JNA patients. Other commonly seen radiographic changes include widening of the inferolateral aspect of the superior orbital fissure, distortion of the roots of the pterygoid plates, erosion of the hard palate, erosion of the medial wall of the maxillary sinus, and displacement of the nasal septum. Of course, the tumor itself will be evident as a soft tissue mass extending into these bony areas. The tumor has a characteristic angiographic appearance in the arterial phase of excessive numbers of dilated, tortuous vessels. In the capillary phase, a homogenous, dense stain is seen. The predominant blood supply of most JNA s is the ipsilateral internal maxillary artery. As it grows, the tumor may parasitize bilateral arterial supply from any nearby vessel. Therefore, bilateral internal and external carotid arteriography is indicated in most patients. In patients who have had previous attempts at surgical resection or who have had previous external carotid ligation, supply from as far away as the vertebrals and thyrocervical vessels has been emonstrated. Arterial embolization has been shown both to decrease intraoperative hemorrhage and to lower rates of tumor recurrence in JNA. Differential diagnosis: paraganglioma Antrochoanal polyp Hemangioma Encephalocele Diagnosis confirmation: Surgery / Histo Category: Other Region / Organ: Head-Nasal sinuses Etiology: neoplastic References: Diagnostic Imaging: Head and Neck By H. Ric Harnsberger, MD, Patricia A. Hudgins, MD, Richard H. Wiggins, III, MD and H. Christian Davidson, MD Get more for Juvenile angiofibromas Peer-reviewed resources Literature  More publications about Juvenile angiofibromasChallenge yourself with the case quiz! |