Epistaxis (plural: epistaxes) is the medical term for a nosebleed, and is very common in clinical practice with a broad differential diagnosis. Anterior epistaxes mainly bleed from Kiesselbach's plexus and posterior epistaxes (5% of all epistaxis) from Woodruff's plexus.
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Epidemiology
Epistaxis is very common, with a lifetime incidence of ~60% 2.
Pathology
Etiology
There is a broad range of causes, both local and systemic 2:
-
local
- digital trauma (most common)
- nasal septal deviation
- neoplasms (rare)
- vascular malformations (rare)
- capillary hemangioma
- hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)
- intracranial aneurysms (very rare)
- chemical irritants
-
systemic
- coagulopathy, congenital (e.g. von Willebrand disease) and acquired (e.g. alcoholism)
- renal failure
- granulomatosis with polyangiitis
Radiographic features
They usually do not require imaging, unless they are very severe or recurrent. In rare instances, these can be evaluated in the interventional radiology suite for potential endovascular embolization, especially if uncontrollable with nasal packing. Ideally, prior to embolization, these cases should be imaged by head and neck CTA.
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