Lou Z-C
Department of Otorhinolaryngology, Yiwu central Hospital, China.
J Laryngol Otol. 2019 Sep;133(9):818-821. doi: 10.1017/S0022215119001701. Epub 2019 Aug 22.
To review the origins of epistaxis in patients with unknown bleeding sites.
This consecutive case series included 26 patients with unknown bleeding sites previously considered to have posterior epistaxis. All patients had previously been examined endoscopically at least once, and were again examined with 30°, 45° and 70° endoscopes.
The bleeding site was at the: anterior end of the lateral wall of the inferior meatus in one patient (3.8 per cent); anterosuperior lateral wall of the nasal cavity in five patients (19.2 per cent); anterior nasal cavity roof in seven patients (26.9 per cent); anterosuperior part of the cartilaginous septum in nine patients (34.6 per cent); ostium pharyngeum tubae in two patients (7.7 per cent); and anterior nasal base in two patients (7.7 per cent). The morphology of the bleeding point showed: nasal mucosa ulceration in 1 patient, isolated primary telangiectasia in 3 patients, prominent vessels in 5 patients and capillary angioma in 17 patients.
Epistaxis originating from the anterosuperior nasal cavity and nasopharynx can be easily misdiagnosed as posterior epistaxis or unknown bleeding sites. Areas that should be considered as possible origins of epistaxis in cases with unknown bleeding sites were identified.
回顾出血部位不明患者鼻出血的起源。
该连续性病例系列包括26例先前被认为是后鼻孔出血但出血部位不明的患者。所有患者此前至少接受过一次内镜检查，并再次使用30°、45°和70°内镜进行检查。
出血部位分别为：1例在下鼻道外侧壁前端（3.8%）；5例在鼻腔前外侧壁（19.2%）；7例在鼻腔顶前部（26.9%）；9例在鼻中隔软骨前上部（34.6%）；2例在咽鼓管咽口（7.7%）；2例在鼻前基部（7.7%）。出血点的形态表现为：1例鼻黏膜溃疡，3例孤立性原发性毛细血管扩张，5例血管突出，17例毛细血管瘤。
起源于鼻腔前上部和鼻咽部的鼻出血容易被误诊为后鼻孔出血或出血部位不明。确定了在出血部位不明的病例中应被视为鼻出血可能起源的区域。
