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Case Report/Case Series |

Intractable Epistaxis Due to Isolated Primary Telangiectasias

Timothy Stoddard, MD, MS1; Todd A. Loehrl, MD1; Bryan C. Hunt, MD2; David M. Poetker, MD, MA1
[+] Author Affiliations
1Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
2Department of Pathology, Medical College of Wisconsin, Milwaukee
JAMA Otolaryngol Head Neck Surg. 2014;140(2):160-163. doi:10.1001/jamaoto.2013.5991.
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Importance  Epistaxis is the most common otolaryngologic emergency in the United States. Most cases are controlled with first-line measures, but intractable epistaxis can be a challenging clinical problem requiring posterior nasal packing and surgical or endovascular intervention. Bleeding from nasal telangiectasias is well known in hereditary hemorrhagic telangiectasia, but there are no reports in the literature of recurrent epistaxis due to isolated telangiectasias not associated with systemic disease. This report describes a series of cases in which intractable epistaxis due to isolated primary telangiectasias was effectively controlled with bipolar electrosurgery.

Observations  We describe a patient with intractable epistaxis that had failed management with posterior packing and embolization. We also report a series of 16 cases of epistaxis, 6 of which were intractable, in adults without hereditary hemorrhagic telangiectasia who received treatment between 2009 and 2012. These cases reveal a common pattern of bleeding from telangiectasias on the anterior septum (8 cases [42%]), nasal sidewall (3 [16%]), inferior meatus (2 [10%]), posterior septum (2 [10%]), nasal floor (2 [10%]), middle turbinate (1 [5%]), and inferior turbinate (1 [5%]).

Conclusions and Relevance  Telangiectasias not associated with systemic disease are a previously unreported source of significant nasal bleeding that, when identified endoscopically, can be treated successfully with bipolar electrosurgery rather than with more invasive and costly surgical and endovascular measures.

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Figure 1.
Endoscopic Photograph of an Isolated Primary Telangiectasia on the Anterior Nasal Septum

Isolated primary telangiectasias were identified as raised red lesions containing a lacy network of blood vessels.

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Figure 2.
Biopsy Section of Bleeding Lesion on Nasal Septum

Hematoxylin-eosin staining reveals reactive sinonasal epithelium with squamous metaplasia and an underlying proliferation of dilated, thin-walled vascular spaces consistent with primary telangiectasia. Original magnification ×10.

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