Question:medium
What is the investigation of choice for nasopharyngeal angiofibroma?
What is the investigation of choice for nasopharyngeal angiofibroma?
Show Hint
JNA is vascular; CECT shows enhancement, bone erosion and Holman-Miller sign.
Updated On: Jun 24, 2026
- X-ray
- MRI
- Plain CT
- CT with contrast
Show Solution
The Correct Option is D
Solution and Explanation
Step 1: The clinical setting is an adolescent boy with recurrent epistaxis and nasal obstruction, pointing to JNA, a very vascular benign nasopharyngeal tumour. The ideal test must capture vascularity plus bone destruction.
Step 2: Adding iodinated contrast to a CT lights up the tumour brilliantly because of its rich blood supply, and CT bone windows reveal erosion and the tell-tale forward push of the back wall of the maxillary antrum. This combination is why CECT is named the investigation of choice.
Step 3: A plain radiograph gives only crude information and cannot stage the lesion. A non-contrast CT misses the dramatic enhancement that confirms the vascular diagnosis. Both are inferior choices.
Step 4: MRI does add value for skull base and intracranial spread and angiography guides embolisation, yet the standard answer for the best diagnostic investigation remains CT with contrast.
\[\boxed{\text{CT with contrast}}\]
Step 2: Adding iodinated contrast to a CT lights up the tumour brilliantly because of its rich blood supply, and CT bone windows reveal erosion and the tell-tale forward push of the back wall of the maxillary antrum. This combination is why CECT is named the investigation of choice.
Step 3: A plain radiograph gives only crude information and cannot stage the lesion. A non-contrast CT misses the dramatic enhancement that confirms the vascular diagnosis. Both are inferior choices.
Step 4: MRI does add value for skull base and intracranial spread and angiography guides embolisation, yet the standard answer for the best diagnostic investigation remains CT with contrast.
\[\boxed{\text{CT with contrast}}\]
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