Nose bleed-etiology

[Hudson]

I apologize if this is boring. How high on you diff would nasopharyngeal tumor be on a 55-60 yo female with unilateral epistaxis intermittently for 1.5 years. The bleeding is almost always accompanied by clumps of clotted blood. No bleeding gums, no vaginal bleeding etc. just the nose. Always unilateral. No infections/allergies/ signs of obstruction/no trauma/pt does not pick nose. No h/o bleeding disorders. Can polyps do this? Maybe angiofibroma? The clotted blood leads me away from some type of vessel erosion. Any thoughts?

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[MustafaMond]

I apologize if this is boring. How high on you diff would nasopharyngeal tumor be on a 55-60 yo female with unilateral epistaxis intermittently for 1.5 years. The bleeding is almost always accompanied by clumps of clotted blood. No bleeding gums, no vaginal bleeding etc. just the nose. Always unilateral. No infections/allergies/ signs of obstruction/no trauma/pt does not pick nose. No h/o bleeding disorders. Can polyps do this? Maybe angiofibroma? The clotted blood leads me away from some type of vessel erosion. Any thoughts?

They should see an ENT.
Benign pseudopolyp causes the same thing, AVM can cause it, also bad hypertension.
If they are a smoker, NPC would be much higher differential

 

[Hudson]

No HTN, Prior h/o smoking. Quit 28 years ago. Total 5-8 pk/yrs.

 

[GopherBrain]

I say she is a closet nose picker.

 

[canuckfan]

Less likely. NPC usually presents late with a cranial nerve palsy, unilateral neck node, or serous OM (secondary to Eustachian tube blockage) due to advanced local disease or mets. Angiofibroma is less likely as well; just not all that common, and would probably bleed a lot more than is indicated. The most likely cause is nasal trauma (from picking), or else she may have an exposed capillary on her septum that bleeds intermittently (very common, particularly in winter/dry air). Polyps are usually bilateral, the exception being the inverting papilloma, which is usually unilateral and can present with epistaxis, although it isn't really a polyp.

In any event, the fastest resolution is to see an ENT, decongest the nose, and stick a scope in. If it's just an exposed capillary, it can be cauterized, and if it's something else, it can be seen on the NP scope.