Delayed post-traumatic intractable epistaxis due to pseudoaneurysms in concha bullosa: a case report
Abstract Background Delayed post-traumatic bleeding at various sites is known due to vascular abnormalities related to structural changes in the vessel walls, in the form of pseudo aneurysms and arteriovenous malformations. Delayed epistaxis following facial trauma is a distinct entity that presents...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2023-05-01
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| Series: | The Egyptian Journal of Otolaryngology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s43163-023-00446-8 |
| _version_ | 1797823030264594432 |
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| author | Shraddha Jain Mithula Murali Vaidehi Hande Aditya Ranjan Pankaj Banode Rupesh Shekawat |
| author_facet | Shraddha Jain Mithula Murali Vaidehi Hande Aditya Ranjan Pankaj Banode Rupesh Shekawat |
| author_sort | Shraddha Jain |
| collection | DOAJ |
| description | Abstract Background Delayed post-traumatic bleeding at various sites is known due to vascular abnormalities related to structural changes in the vessel walls, in the form of pseudo aneurysms and arteriovenous malformations. Delayed epistaxis following facial trauma is a distinct entity that presents as recurrent episodes of bleeding from the nose. History of trauma is important to differentiate it from idiopathic intractable epistaxis, the management of which is less dramatic in the beginning in the form of endoscopy and electrocauterization. However, uncontrolled post-traumatic delayed epistaxis usually requires embolization. We report a rare case of intractable epistaxis associated with multiple pseudoaneurysms (PA), due to bleeding inside concha bullosa, where even embolization was unsuccessful. Case presentation A 25-year-old male patient presented to casualty and was referred to the Otorhinolaryngology department for recurrent profuse bleeding from left nasal cavity, where conservative measures like nasal packing, and electrocauterization did not help. Patient had a history of fall from height with facial bone fractures 1 month back. Angiography revealed blush with dilatation (pseudoaneurysms) in the nasal branches of internal maxillary arteries, ascending pharyngeal and labial arteries and embolization was done in the Interventional Radiology Department. Post-embolization, the patient again developed massive epistaxis. The patient was explored under general anaesthesia, to find out the site of bleed by nasal endoscopy. Collected blood was found in the left concha bullosa. Conchoplasty of the left middle turbinate was done with cauterization of bleeding vessels. The patient had no further epistaxis and was discharged in stable condition. He is asymptomatic for the last 6 months. Conclusion Post-traumatic pseudoaneurysms is a rare cause of delayed epistaxis following nasal trauma. Angiography helps in the localization of the source of bleeding inside nasal cavity and can identify pseudoaneurysmal dilatations of vessels. Our case highlights the importance of hidden bleeding points inside concha bullosa as a source of intractable epistaxis unresponsive to embolization. |
| first_indexed | 2024-03-13T10:18:06Z |
| format | Article |
| id | doaj.art-a461e15fd80048559fcb853d242c6863 |
| institution | Directory Open Access Journal |
| issn | 2090-8539 |
| language | English |
| last_indexed | 2024-03-13T10:18:06Z |
| publishDate | 2023-05-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | The Egyptian Journal of Otolaryngology |
| spelling | doaj.art-a461e15fd80048559fcb853d242c68632023-05-21T11:06:32ZengSpringerOpenThe Egyptian Journal of Otolaryngology2090-85392023-05-013911510.1186/s43163-023-00446-8Delayed post-traumatic intractable epistaxis due to pseudoaneurysms in concha bullosa: a case reportShraddha Jain0Mithula Murali1Vaidehi Hande2Aditya Ranjan3Pankaj Banode4Rupesh Shekawat5Department of Otorhinolaryngology, Jawahar Lal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University)Department of Otorhinolaryngology, Jawahar Lal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University)Department of Otorhinolaryngology, Jawahar Lal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University)Department of Otorhinolaryngology, Jawahar Lal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University)Department of Interventional Radiology, Jawahar Lal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University)Department of Otorhinolaryngology, Jawahar Lal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University)Abstract Background Delayed post-traumatic bleeding at various sites is known due to vascular abnormalities related to structural changes in the vessel walls, in the form of pseudo aneurysms and arteriovenous malformations. Delayed epistaxis following facial trauma is a distinct entity that presents as recurrent episodes of bleeding from the nose. History of trauma is important to differentiate it from idiopathic intractable epistaxis, the management of which is less dramatic in the beginning in the form of endoscopy and electrocauterization. However, uncontrolled post-traumatic delayed epistaxis usually requires embolization. We report a rare case of intractable epistaxis associated with multiple pseudoaneurysms (PA), due to bleeding inside concha bullosa, where even embolization was unsuccessful. Case presentation A 25-year-old male patient presented to casualty and was referred to the Otorhinolaryngology department for recurrent profuse bleeding from left nasal cavity, where conservative measures like nasal packing, and electrocauterization did not help. Patient had a history of fall from height with facial bone fractures 1 month back. Angiography revealed blush with dilatation (pseudoaneurysms) in the nasal branches of internal maxillary arteries, ascending pharyngeal and labial arteries and embolization was done in the Interventional Radiology Department. Post-embolization, the patient again developed massive epistaxis. The patient was explored under general anaesthesia, to find out the site of bleed by nasal endoscopy. Collected blood was found in the left concha bullosa. Conchoplasty of the left middle turbinate was done with cauterization of bleeding vessels. The patient had no further epistaxis and was discharged in stable condition. He is asymptomatic for the last 6 months. Conclusion Post-traumatic pseudoaneurysms is a rare cause of delayed epistaxis following nasal trauma. Angiography helps in the localization of the source of bleeding inside nasal cavity and can identify pseudoaneurysmal dilatations of vessels. Our case highlights the importance of hidden bleeding points inside concha bullosa as a source of intractable epistaxis unresponsive to embolization.https://doi.org/10.1186/s43163-023-00446-8EpistaxisPseudoaneurysmEmbolizationNose |
| spellingShingle | Shraddha Jain Mithula Murali Vaidehi Hande Aditya Ranjan Pankaj Banode Rupesh Shekawat Delayed post-traumatic intractable epistaxis due to pseudoaneurysms in concha bullosa: a case report The Egyptian Journal of Otolaryngology Epistaxis Pseudoaneurysm Embolization Nose |
| title | Delayed post-traumatic intractable epistaxis due to pseudoaneurysms in concha bullosa: a case report |
| title_full | Delayed post-traumatic intractable epistaxis due to pseudoaneurysms in concha bullosa: a case report |
| title_fullStr | Delayed post-traumatic intractable epistaxis due to pseudoaneurysms in concha bullosa: a case report |
| title_full_unstemmed | Delayed post-traumatic intractable epistaxis due to pseudoaneurysms in concha bullosa: a case report |
| title_short | Delayed post-traumatic intractable epistaxis due to pseudoaneurysms in concha bullosa: a case report |
| title_sort | delayed post traumatic intractable epistaxis due to pseudoaneurysms in concha bullosa a case report |
| topic | Epistaxis Pseudoaneurysm Embolization Nose |
| url | https://doi.org/10.1186/s43163-023-00446-8 |
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