 There is redemonstration of an avidly enhancing mass with associated flow-voids centered in the left sphenopalatine foramen consistent with residual juvenile nasopharyngeal angiofibroma. Anteriorly, it extends minimally into the left posterior choana. The previously referenced mass is slightly decreased in size and marginal convexity, now measuring 2.2 x 2.5 cm on 1001/26, compared to previous comparable measurements of 2.8 x 2.8 cm. However, there is now a bilobed appearance with increased caudal extension along the paratracheal space, to the level just caudal to the upper left palatine tonsil which itself is minimally medially displaced. Additional prominent flow-voids are identified just caudal to the enhancing inferior lobule. This more caudal lobule of soft tissue enhancement measures 1.2 x 2.3 cm on 1001/34. The overall craniocaudal extent now measures 3.9 cm, previously 3.3 cm.There is a stable nonspecific oval T2 hyperintense focus along the floor of the left middle cranial fossa measuring approximately 6 mm of uncertain exact etiology (501/14 and 801/22). There is associated enhancement noted. However, correlating with previous CT, there is asymmetric thickening of the surrounding osseous floor of the left middle cranial fossa with ground glass appearance, and a small benign-appearing lucency with thin sclerotic margins, corresponding to the area of T2 abnormality, likely relating to an area of fibrous dysplasia. It is located just lateral to the left foramen ovale, as seen on prior CT.Visualized intracranial structures are unremarkable except for redemonstration of focal extra-axial prominence of CSF signal intensity along the medial aspect of the left middle cranial fossa consistent with an arachnoid cyst, with associated mild localized mass effect. There is mild scattered mucosal thickening in the visualized paranasal sinuses. There is prominent susceptibility likely secondary to dental amalgam. There is a small left frontal lobe developmental venous anomaly.
1. Interval slight decreased size of previously referenced and subsequently reportedly treated lobule of residual enhancing mass centered in the left sphenopalatine foramen consistent with residual JNA, although now with increased caudal extent along the left parapharyngeal space and essentially demonstrating more of a bilobed appearance, with mild localized mass effect on the left palatine tonsil. This is consistent with JNA progression.2. Stable 6 mm area of persistent T2 oval hyperintensity along the floor the left middle cranial fossa demonstrating homogeneous enhancement, which when correlating with prior CT appears to represent a small benign-appearing lucent lesion in an area of asymmetric osseous thickening and ground glass opacity, most likely relating to underlying fibrous dysplasia. Although the T2 hyperintense lesion suggests a focal cystic component of fibrous dysplasia, the enhancement suggests possibly more of a fibrocystic component which results in a differential CT appearance.