Epistaxis | pacs

A maid puts

a key down a man"s shirt to stop his nosebleed. Lithograph, c. 1835-1841 Iconographic Collections

Imaging to

intervention: a review of what the Interventionalist needs to Know about Hereditary Hemorrhagic Telangiectasia. A and B 45-year-old male who presented with uncontrollable epistaxis. AP and lateral right internal maxillary angiogram show a prominent blush over the right nasal cavity (small black arrow) with areas of prominent pooling of contrast (thick black arrow)

CVIRendovasc.springeropen.com • CC-by-4.0

Imaging to

intervention: a review of what the Interventionalist needs to Know about Hereditary Hemorrhagic Telangiectasia. A and B AP and lateral right internal maxillary angiogram after embolization of the distal branches of the internal maxillary artery with 300–500 μm embospheres and gelfoam pledgets shows truncation of the distal internal maxillary artery (small black arrow) with no vascular blush

CVIRendovasc.springeropen.com • CC-by-4.0

Radiopaedia • CC-by-nc-sa 3.0 • de

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.

Epidemiology

Epistaxis is very common, with a lifetime incidence of ~60% .

Pathology

Etiology

There is a broad range of causes, both local and systemic :

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.