The high prevalence of inflammatory disease in pediatric patients makes the occurrence of prominent adenoidal tissue and cervical adenopathy a common finding. Unfortunately, rare nasopharyngeal cancer shares these physical findings in common with benign inflammatory disease of the pharynx. Computed tomography permits evaluation of nodal necrosis or wall nodularity, allowing clinically silent submucosal tumor extension to be well defined. In patients with suspected nasopharyngeal inflammatory disease who do not respond to conservative therapy, computed tomography can be used to aid directed biopsies.