Neuro_MR_Orbit: 15 M, nasal mass and epistaxis.

CLINICAL HISTORY: 15-year-old male with nasal cavity mass.

FINDINGS: 

A large heterogeneously enhancing T1 hypointense, T2 hyperintense partially loculated mass centered in the region of the sphenopalatine foramen and extends into the left nasal cavity and infratemporal fossa. It measures 7.7 cmanterior-posterior, 4.6 cm transverse and 3.5 cm craniocaudal. There is

adjacent opacification of the left ethmoid air cells. The mass extends into and expands the pterygopalatine fossa and appears to invade the clivus posteriorly. The mass extends into the left aspect of the nasopharynx and approaches the left orbital apex. It extends into the middle cranial fossa. The mass also appears to extend into the left cavernous sinus and abuts the left internal carotid artery. The left internal carotid artery does not appear to be narrowed. Appears to fill the left sphenoid sinus. A serpiginous flow-void is seen at the lateral aspect of the mass is seen on coronal image 23. No intracranial extra-axial fluid collections, mass-effect or midline shift.

Ventricles, sulci, and cisterns appear to be within normal limits. No abnormal enhancing intracranial masses. There is no abnormal signal intensity, enhancement, or enlargement of  the optic nerves. The optic chiasm appears to be

unremarkable. Extraocular muscles demonstrate normal moderate symmetric enhancement with no enlargement.  No extraconal or intraconal masses identified. There is mild mucosal thickening in the left greater than right maxillary

sinuses.

IMPRESSION:

A large heterogeneous mixed cystic and solid enhancing mass involving the left nasal cavity, nasopharynx, infratemporal fossa, pterygopalatine fossa, clivus, left orbital apex  and middle cranial fossa.  Differential diagnosis includes juvenile angiofibroma , sinonasal hemangioma, inverting papilloma and less likely encephalocele or esthesioneuroblastoma.