Computed tomography findings in patients with primarily unknown causes of severe or recurrent epistaxis

Abstract

Objective In addition to rhinoscopy, computed tomography of paranasal sinuses (CT) may be performed on patients with primary unknown cause of severe epistaxis (SE) or recurrent epistaxis (RE) to further assess the potential cause of bleeding. The aim of this study was to evaluate CT findings during the work-up of intractable epistaxis patients. Methods 6937 patients were treated in our emergency department with acute epistaxis between 2009–2018. 304/6937 patients underwent CT and rhinoscopy due to intractable SE or RE. 33 patients presented with head trauma prior to epistaxis and were excluded from the final analysis. In 271 cases the primary causes of SE (n = 252) or RE (n = 19) remained unknown. Two observers retrospectively evaluated CT scans for potential sources of epistaxis. Disagreement was settled by consensus. CT and rhinoscopy findings were compared. Results In 247/271 (91.1%) SE patients no related pathology was found on CT. A possible cause for epistaxis was found in all RE patients, but only in 5/252 (1.9%) patients with SE. Most tumours (10/11) and inflammatory conditions (9/10) were found in patients with RE. In three SE cases, a tumour was suspected on CT, from which two suspicions were refuted during rhinoscopy. CT revealed 10 cases of inflammatory conditions of the sinus and anatomical variant as potential cause of bleeding. Conclusion For patients with unknown causes of epistaxis, supplementary CT imaging may be a useful diagnostic add-on to rhinoscopy in the event of RE, tumour suspicion or inflammation of the paranasal sinuses. However, in most cases of first-time SE, CT does not necessarily add to the diagnosis. In these cases, the marginal benefit of CT needs to be weighed carefully against its risks.

Concha bullosa mucocele disguising as a nasal tumor in an epistaxis patient: A case report

“…CT helps to differentiate among nasal mass and reason of epistaxis in such situation. 6 On the CT scan, a non-enhancing, homogeneous, hypodense, well-defined, rounded, expansile lesion suggestive of mucocele was found. Typically, there is a rim enhancement due to inflammatory and hyperplastic mucosa.…”

“…There are several causes of epistaxis like trauma, hypertension, bleeding diathesis, nasal tumor, and many more. 1 In cases of unilateral nasal mass in old patients, nasal tumor has to be ruled out. Concha bullosa (CB) is a normal anatomical variant of the middle turbinate in both adults and children.…”

Analysis of Bleeding Site to Identify Associated Risk Factors of Intractable Epistaxis

“…Epistaxis is one of the most common emergencies in otolaryngology, 1 affecting 12% of the population each year, where around 6% to 10% of these cases require medical treatment in the hospital. 2 Although the majority of nasal bleeding can be treated with conventional local compression, vasoconstrictor and nasal packing; intractable epistaxis cannot be controlled as easily due to the depth of the bleeding site, abnormal nasal anatomy, and uncontrolled persistent bleeding. 3 , 4 Our previous study had found that the responsible arteries for intractable epistaxis are mainly the sphenopalatine artery and the anterior or posterior ethmoidal artery.…”