Juvenile angiofibroma


  • The most common benign nasopharyngeal tumour. It is probably hamartomatous in origin. Although benign it can grow to an enormous size and invade local structures.
  • It is seen virtually exclusively in males, usually in teenagers.
  • It is a highly vascular tumour which can present with severe epistaxis. Biopsy is extremely hazardous due to the risk of haemorrhage. Part of the radiological work up should assess the extent of the lesion and its vascularity. Some require embolisation prior to surgery to reduce the blood supply.
  • MR is better at showing the soft tissue extent of the tumour. Subtle bone destruction requires CT.
  • Characteristically the tumour is of low to intermediate signal intensity on both T1 and T2 weighted sequences. Discrete punctate areas of hypointensity are seen due to flow void channels in highly vascular stroma.
  • Bronchopulmonary sequestration

    • Is more common in males.
    • Is more common on the left. Usually the posterior basal segment of the left lung lower lobe.
    • May communicate with the oesophagus. It arises as an accessory tracheobronchial foregut bud, hence its systemic arterial supply.
    • Intralobar is more common than extralobar sequestration. Intralobar is about 3 times more common and usually presents in adulthood. It is enclosed by the visceral pleura of the affected pulmonary lobe.
    • Systemic feeding vessels originate from the descending thoracic aorta. Vascular drainage into the left atrium occurs through the normal pulmonary veins resulting in a left-to-left shunt. Associated congenital abnormalities are rare.
    • Extralobar sequestration has its own pleural sheath which prevents collateral air drift and usually presents in neonates. 90% are contiguous with the left hemidiaphragm in the thorax.
    • Systemic feeding vessels commonly originate from the thoracic or abdominal aorta (80%), or from the splenic, gastric, subclavian or intercostal arteries. Vessels drain into the systemic circulation through the IVC, azygos or hemiazygos veins. Associated congenital abnormalities are frequent.