Prepared by Naveen Saini, Medical Student, and Rajesh Sethi, MD, Assistant Professor, Neuroradiology Division, Department of Radiology, University of Arkansas for Medical Sciences, Little Rock

An 18-year-old man presents to the clinic complaining of recurrent epistaxis. He denies any chills, night sweats, or cough. He states that the nosebleeds have progressively increased in duration and frequency over the past 3 months. He has no history of any bleeding disorder. Physical examination reveals a dark mass protruding from the posterior nasal wall. Laboratory test results are within normal range. Vital signs are normal. The coronal and axial T2-weighted magnetic resonance imaging (MRI) scans are shown (Figures 1, 2).

What’s Your Diagnosis?

Wegener’s granulomatosis

Juvenile angiofibroma

Non-Hodgkin’s lymphoma

Invasive fungal sinusitis