Karydes Harry C, Bailitz John M
Department of Emergency Medicine, Cook County Hospital (Stroger), Chicago, Illinois 60612, USA.
J Emerg Med. 2012 Oct;43(4):e231-3. doi: 10.1016/j.jemermed.2010.02.012. Epub 2010 Apr 9.
Epistaxis is a common complaint seen in the younger population. Its etiology is typically from the anterior nares, although we present a case of epistaxis from an uncommon source-juvenile nasopharyngeal angiofibroma. Juvenile nasopharyngeal angiofibroma (JNA) is a highly vascular, benign, yet locally invasive tumor that occurs in preadolescent males.
To illustrate a case of epistaxis from an uncommon source.
A 21-year-old man with a past medical history of allergic rhinitis presented to the Emergency Department (ED) after 6 months of intermittent yet worsening epistaxis. He described the bleeding as sudden onset that resolved after 30 min of direct compression of the external nares. He denied any history of digital manipulation, trauma, or bleeding disorders. Upon arrival in the ED, he had brisk bleeding from the right naris that was initially controlled with phenylephrine nasal spray. A small round friable mass was visualized in the right posterior nasal cavity. Further hemostasis of the epistaxis was achieved using a nasal tampon moistened with phenylephrine, and a computed tomography scan of the sinus revealed a soft tissue mass almost completely occupying the sphenoid sinus and extending into the nasopharynx and posterior ethmoids. There was also expansion and bony erosion of the right pterygopalatine fossa. A final diagnosis of JNA was made and the patient was given follow-up with an otorhinolaryngologist, who ultimately surgically resected the mass.
JNA is a highly vascular, benign, yet locally invasive tumor that occurs in preadolescent males. This case illustrates the importance of appreciating the more uncommon cases of epistaxis, especially when conventional methods of treatment have initially failed.
鼻出血是年轻人群中常见的症状。其病因通常来自前鼻孔，不过我们报告了一例鼻出血源于不常见病因——青少年鼻咽血管纤维瘤的病例。青少年鼻咽血管纤维瘤（JNA）是一种血管丰富、良性但具有局部侵袭性的肿瘤，发生于青春期前男性。
举例说明一例源于不常见病因的鼻出血病例。
一名有过敏性鼻炎病史的21岁男性，在间歇性鼻出血且病情逐渐加重6个月后就诊于急诊科。他描述出血为突然发作，经直接压迫外鼻孔30分钟后出血停止。他否认有任何手指抠鼻、外伤或出血性疾病史。到达急诊科时，他右侧鼻孔有活跃出血，最初用去氧肾上腺素鼻喷雾剂控制住了出血。在右侧后鼻腔可见一个小的圆形易碎肿物。使用浸有去氧肾上腺素的鼻填塞物进一步止血，鼻窦计算机断层扫描显示一个软组织肿物几乎完全占据蝶窦，并延伸至鼻咽部和后筛窦。右侧翼腭窝也有扩大和骨质侵蚀。最终诊断为JNA，患者被转至耳鼻喉科医生处随访，最终该肿物被手术切除。
JNA是一种血管丰富、良性但具有局部侵袭性的肿瘤，发生于青春期前男性。该病例说明了认识到鼻出血更不常见病例的重要性，尤其是在传统治疗方法最初失败时。
