Question

An 18-year-old boy presents with epistaxis and a unilateral nasal mass. The most likely diagnosis is

• A. Rhinoscleroma
• B. Antrochoanal polyp
• C. Rhinosporidiosis
• D. Angiofibroma

Hint:

Think about which nasal mass is famous for occurring almost only in teenage boys and bleeding heavily.

Answer 1

The Correct Option is D

Step 1: Understanding the Question:
This is a classic clinical vignette — an adolescent male with recurrent epistaxis and a one-sided nasal mass — and the question asks for the most likely diagnosis.

Step 2: Key Concept or Approach:
The age and sex profile is the key clue. Juvenile nasopharyngeal angiofibroma is a highly vascular, benign but locally aggressive tumour that occurs almost exclusively in adolescent males, arising near the sphenopalatine foramen and presenting with unilateral nasal obstruction and recurrent, often severe, epistaxis.

Step 3: Working Through the Options:
Rhinoscleroma is a chronic granulomatous infection caused by Klebsiella rhinoscleromatis that produces nasal deformity and crusting rather than an acute vascular mass with epistaxis as the dominant feature. Antrochoanal polyp typically causes nasal obstruction in children or young adults but is not vascular and does not classically present with significant epistaxis. Rhinosporidiosis produces a friable, strawberry-like mass that can bleed, but it is not specific to adolescent males and lacks the characteristic vascularity and skull-base extension of angiofibroma. Angiofibroma fits both the age/sex pattern (adolescent male) and the presentation (unilateral mass with brisk epistaxis due to its rich vascular supply), making it the most likely diagnosis.

Step 4: Conclusion:
Angiofibroma (juvenile nasopharyngeal angiofibroma) is the most likely diagnosis in this adolescent boy with epistaxis and a unilateral nasal mass.