Epistaxis caused by hemangioma of the inferior turbinate.

A 58-year-old woman presented with a 4-month history of intermittent right-sided nasal bleeding and facial pain. She had no history of hypertension or bleeding disorder, and she was taking no anticoagulant or aspirin. Nasal endoscopy detected a friable soft-tissue mass above the right inferior turbinate (figure, A). Axial computed tomography (CT) of the sinuses showed opacification of the right maxillary sinus (figure, B).

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The patient underwent endoscopic right nasal and sinus surgery with biopsy. The right intranasal mass was attached to the superior portion of the inferior turbinate (figure, C). The mass had not extended into the sinuses (figure, D). The opacification of the right maxillary sinus was attributable to mucopurulent material rather than to soft tissue or a tumor. An antrostomy was created through the right middle meatus, and the maxillary sinus was cleaned. An excisional biopsy of the intranasal mass was obtained, and pathologic examination revealed the specimen to be a benign capillary hemangioma. The maxillary antrostomy healed well, and the patient experienced no further nasal bleeding.

Unilateral nasal bleeding is frequently encountered in the daily otolaryngology practice. It is usually caused by rupture of a vessel in the nasal mucosa. It can be treated with cautery, nasal tamponade or, in rare cases, vessel ligation or embolization. (1)

When unilateral nasal bleeding is accompanied by unilateral nasal or sinus findings, a full evaluation is indicated. A thorough endoscopic evaluation is warranted for not only the nasal septum, but also the lateral walls of the nasal cavity, including the meatus. Unilateral bleeding in the presence of a soft-tissue mass should certainly suggest the possibility of a malignancy in the nose or sinus; a biopsy of the soft tissue should be performed. (2)

In the case described herein, the maxillary sinus findings triggered the evaluation of the ostiomeatal complex. Removal of the hemangioma resulted in no further nasal bleeding.

References

(1.) Christmas DA, Yanagisawa E, Pastrano JA. Transnasal endoscopic ligation of the sphenopalatine artery. Ear Nose Throat J 1998;77: 524-5.

(2.) Christmas DA Jr., Marotta JC, Yanagisawa E. Nasal malignancy masquerading as polyposis: Importance of biopsy in powered endoscopic sinus surgery. Ear Nose Throat J 2001;80:856-7.

Joseph P. Mirante, MD; Dewey A. Christmas, MD; Eiji Yanagisawa, MD

From the Department of Otolaryngology, University of South Florida College of Medicine, Tampa, and the Halifax Medical Center, Daytona Beach, Fla. (Dr. Mirante and Dr. Christmas); and the Southern New England Ear, Nose, Throat, and Facial Plastic Surgery Group; the Section of Otolaryngology, Hospital of St. Raphael; and the Section of Otolaryngology, Yale University School of Medicine, New Haven, Conn. (Dr. Yanagisawa).