Nasopharyngeal angiofibroma is a benign yet locally aggressive tumor. It most commonly occurs in males before the age of 20 years old. It is uniquely comprised of fibrous stroma and a mixture of blood vessels with abundant endothelial and fibroblast cells making it very intricate and delicate. This tumor usually arises in the nasopharynx region near the choanae. Being a space-occupying lesion, it can locally compress nearby structures leading to various clinical presentations such as difficulty in nasal breathing, recurrent severe epistaxis, and unilateral facial swelling. The pathogenesis is unclear, but it may be associated with puberty and circulating hormones. Diagnosis of this tumor is made with complete patient history, physical examination, radiography, nasal endoscopy along with using specialized imaging like arteriography, computer tomography and MRI. Here we present a case of nasopharyngeal angiofibroma in a 48-year-old woman, and we review the literature.

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This report presents the case of a 39-year-old male with a history of hoarseness, odynophagia, and dyspnea. Initial examination revealed right vocal fold hypomobility with inter-arytenoid erythema. Three years later, the patient re-presented with similar symptoms in addition to breathy speech and right-sided otalgia. CT of neck and chest revealed asymmetric enlargement of the right piriform sinus, a 2.1 cm air density at the right posterolateral trachea with mass effect on the right lateral esophageal wall. Despite suggestive symptoms, laryngoscopy and CT scans did not detect any neoplasm, making aerodigestive malignancy unlikely. A laryngocele was unlikely given that most present are contained within the larynx or the cervical tissues, unlike this mass. The presence of tracheal diverticulum, a rare condition, was identified as etiology based on the patient’s symptoms and imaging findings. Tracheal diverticula are congenital or acquired, with the latter often presenting in the right posterolateral trachea at the thoracic inlet. Symptoms can vary widely but may include dysphagia, chronic cough, dyspnea, or dysphonia, as seen in this case because of recurrent laryngeal nerve compression. Diagnosis typically involves CT imaging of the neck and chest, with bronchoscopy and barium esophagogram as supplementary diagnostic tools. Treatment options range from observation and symptom management to surgical resection, depending on symptom severity and patient preference. In this case, the patient was referred for evaluation but declined follow-up. Understanding the clinical presentation and diagnostic approach to tracheal diverticula is crucial for accurate diagnosis and appropriate management of affected individuals.