ABSTRACT
BACKGROUND: Paranasal sinus angiosarcoma is an uncommon malignancy, with only a few reported cases worldwide. Although it exhibits multiple symptoms, facial paralysis has not been previously documented as a noticeable presentation. CASE PRESENTATION: In this case, we report a 40-year-old male who presented with facial numbness and pain for one month, weakness of his facial muscles for 15 days, and recurrent right epistaxis for 1 year. He had a history of nasal inflammatory polyps with chronic sinusitis. Computed tomography and magnetic resonance imaging showed space-occupying lesions in the right nasal cavity and maxillary sinus, with bone destruction occurring in the sinus wall and turbinate. This patient then underwent endoscopic surgery. According to the histopathological and immunohistochemical results, he was eventually diagnosed with paranasal sinus angiosarcoma in April 2021. To date, this patient has not initiated any radiotherapy or chemotherapy and has survived with lymphatic metastasis for at least 3 years. CONCLUSIONS: This manuscript suggests that paranasal sinus angiosarcoma can present with facial paralysis. Moreover, pathological and immunohistochemical tests are still vital for diagnosing paranasal sinus angiosarcoma and differential diagnosis. Additionally, regular follow-up is crucial for patients with paranasal sinus angiosarcoma, enabling monitoring of recurrence, metastasis, and recovery while contributing valuable clinical data to understanding this rare disease and associated research endeavours.
Subject(s)
Facial Paralysis , Hemangiosarcoma , Male , Humans , Adult , Hemangiosarcoma/diagnosis , Hemangiosarcoma/diagnostic imaging , Facial Paralysis/etiology , Maxillary Sinus/diagnostic imaging , Maxillary Sinus/pathology , Nasal Cavity/pathology , Epistaxis/pathologySubject(s)
Chondrosarcoma , Chordoma , Nervous System Diseases , Skull Base Neoplasms , Humans , Middle Aged , Petrous Bone/diagnostic imaging , Petrous Bone/pathology , Epistaxis/pathology , Skull Base Neoplasms/complications , Skull Base Neoplasms/diagnostic imaging , Chondrosarcoma/complications , Chondrosarcoma/diagnostic imaging , Headache/diagnostic imaging , Headache/etiologyABSTRACT
This article presents the case of a 33-year-old woman who consulted the authors' ENT clinic in the 39th week of pregnancy with recurrent epistaxis. A livid endonasal mass was found on the left side, subtotally displacing the nose and leading to deformation of the external nose. External biopsy provided no indications of malignancy. Postpartum CT of the paranasal sinuses revealed a mass destroying the cartilaginous nasal septum. Endoscopic resection of the finding was performed with preservation of the clinically sound nasal septal cartilage. Histopathological examination revealed a capillary hemangioma, which was classified as granuloma gravidarum due to its occurrence during pregnancy.
Subject(s)
Epistaxis , Hemangioma, Capillary , Nasal Cartilages , Nose Deformities, Acquired , Pregnancy Complications, Hematologic , Pregnancy Complications, Neoplastic , Humans , Female , Pregnancy , Adult , Epistaxis/diagnostic imaging , Epistaxis/pathology , Recurrence , Pregnancy Complications, Hematologic/diagnostic imaging , Pregnancy Complications, Hematologic/pathology , Biopsy , Nose Deformities, Acquired/diagnostic imaging , Nose Deformities, Acquired/pathology , Nasal Cartilages/diagnostic imaging , Nasal Cartilages/pathology , Hemangioma, Capillary/diagnostic imaging , Hemangioma, Capillary/pathology , Pregnancy Complications, Neoplastic/diagnostic imaging , Pregnancy Complications, Neoplastic/pathologyABSTRACT
BACKGROUND Hemangiomas are commonly located in the head and neck and rarely in the paranasal sinuses. These are benign vascular lesions, but with an increased risk of bleeding. The surgical approach must have detailed prior planning, given the increased risk of intraoperative bleeding. We herein describe the case of a 32-year-old male patient with recurrent epistaxis, nasal obstruction, and facial deformity due to a giant cavernous hemangioma successfully treated by endoscopic sinus surgery. CASE REPORT A 32-year-old man had nasal obstruction and intermittent epistaxis for 2 months. Physical examination also revealed facial deformity with enlargement of the nasal base and bulging in the maxillary region on the right. A soft and friable lesion occupying the entire right nasal cavity without bone erosion was observed on computed tomography (CT scan). Before surgery, the patient underwent angiographic evaluation, with evidence of main irrigation of the lesion by the right maxillary artery, which was then embolized. The patient underwent endoscopic nasal surgery. He maintained postoperative follow-up for 18 months, without recurrence of the lesion. Anatomopathological examination confirmed a cavernous hemangioma. CONCLUSIONS Cavernous hemangioma is a benign lesion of the paranasal sinuses. Due to non-specific clinical and radiological findings, its preoperative diagnosis is always challenging. The high index of suspicion of the malignancy should only be discarded after complete anatomopathological evaluation. A correct diagnosis is essential to avoid facial anatomical remodeling while excluding the diagnosis of other malignant lesions.
Subject(s)
Hemangioma, Cavernous , Nasal Obstruction , Adult , Epistaxis/etiology , Epistaxis/pathology , Hemangioma, Cavernous/diagnostic imaging , Hemangioma, Cavernous/surgery , Humans , Male , Maxillary Sinus/diagnostic imaging , Maxillary Sinus/pathology , Nasal Cavity/pathology , Nasal Obstruction/etiologyABSTRACT
BACKGROUND: Sinonasal cavernous hemangioma is rare. To date, fewer than 20 cases have been reported in the literature; however, they may be a source of recurrent epistaxis and masquerade of a hemorrhagic mass on CT and MRI. CASE REPORT: A 68-year-old woman was presented with recurrent epistaxis and progressive right malar fullness. On rhinoscopy, a bulge lesion was observed with multifocal hemorrhagic and friable surfaces in the right nasal cavity. CT and MRI demonstrated a well-defined mass in the right maxillary sinus with inhomogenous T2 hyperintensity, hypointense septa, peripheral rim, and multiple papillary enhancement, suggesting a recurrent hemorrhagic mass. The mass was excised endoscopically, and the histologic diagnosis was cavernous hemangioma. CONCLUSION: Imaging studies, such as CT and MRI, are essential in making an accurate diagnosis of cavernous hemangioma of the maxillary sinus. Endoscopic excision of the lesion can be curative.
Subject(s)
Hemangioma, Cavernous , Maxillary Sinus , Aged , Epistaxis/diagnostic imaging , Epistaxis/etiology , Epistaxis/pathology , Female , Hemangioma, Cavernous/diagnostic imaging , Hemangioma, Cavernous/surgery , Humans , Magnetic Resonance Imaging , Maxillary Sinus/diagnostic imaging , Maxillary Sinus/pathology , RadiographyABSTRACT
Epistaxis is commonly seen as an acute presentation to the emergency department. The level of severity can range from a minor ooze to a life-threatening bleed. The initial management is often the responsibility of junior doctors working in otolaryngology or the emergency department, so they must be familiar with the initial steps in treating this often distressing condition. The COVID-19 pandemic has complicated matters further as much of the management takes place in the upper airway. This article outlines the key considerations in the management of epistaxis, especially during the COVID-19 pandemic.
Subject(s)
COVID-19/epidemiology , Epistaxis/pathology , Epistaxis/therapy , Medical Staff, Hospital/education , Epistaxis/etiology , Humans , Pandemics , Risk Factors , SARS-CoV-2 , Severity of Illness IndexABSTRACT
Renal cell carcinoma (RCC) is a malignant disease that is often diagnosed at a metastatic stage. The head and neck represent up to 3% of the metastatic RCC, and the paranasal sinus area is one of the least involved sites. Here, we introduce the case of a 74-year-old female patient who presented with a history of traumatic nasal bleed. A cranial computed tomography scan and magnetic resonance imaging showed a fronto-ethmoidal mass with pachymeningeal involvement. A nasal biopsy from the paranasal sinuses was taken. On histopathological examination, metastatic clear cell carcinoma was the main hypothesis, which later was confirmed to be RCC on immunohistochemistry. On further radiological examination, an exophytic mass was depicted in the kidney's upper and middle pole. The patient had no renal complaints and was asymptomatic. Fronto-ethmoidal sinus is a rare site for metastatic RCC, especially in cases where the patient is asymptomatic. Early detection by keeping RCC metastasis as the differential diagnosis in such cases can lead to early treatment and improve the overall survival of the patient.
Subject(s)
Humans , Female , Aged , Paranasal Sinuses , Carcinoma, Renal Cell/complications , Kidney Neoplasms/pathology , Epistaxis/pathology , Diagnosis, DifferentialABSTRACT
Spontaneous epistaxis in patients with COVID-19 can represent a clinical challenge with respect to both the risk of contamination and the treatment options. We herein present the data of 30 patients with COVID-19 who developed spontaneous epistaxis while hospitalized at Eastern Piedmont Hospital during March and April 2020. All patients received low-molecular-weight heparin during their hospital stay and required supplementary oxygen therapy either by a nasal cannula or continuous positive airway pressure. Both conditions can represent risk factors for developing epistaxis. Prevention of crust formation in patients with rhinitis using a nasal lubricant should be recommended. If any treatment is required, appropriate self-protection is mandatory.
Subject(s)
Coronavirus Infections/pathology , Epistaxis/pathology , Oxygen Inhalation Therapy/methods , Pneumonia, Viral/pathology , Aged , Betacoronavirus , COVID-19 , Cannula , Continuous Positive Airway Pressure , Epistaxis/virology , Female , Heparin/adverse effects , Humans , Male , Middle Aged , Nasal Mucosa/injuries , Pandemics , SARS-CoV-2ABSTRACT
The different sets of criteria for diagnosis or classification of anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) lead to numerous overlapping and reclassified diagnoses in clinical practice. We designed this study to assess the difficulties in classifying patients with AAV. As a secondary objective, different variables were tested to predict prognosis. We conducted a retrospective chart review in a Western Spain multicentre survey. A total of 115 adult patients diagnosed with AAV from 2002 to 2013 and followed for at least 3 years were included. They were classified according to (1) Chapel Hill Consensus Conference (CHCC), (2) European Medicines Agency algorithm and (3) French Vasculitis Study Group/European Vasculitis Society phenotypes. Fifty-three patients (46%) had neither distinctive histopathological data of a single AAV definition nor any surrogate markers for granulomatous inflammation and thus did not fulfill any diagnostic criteria. Ocular, ear, nose, throat, skin, and lung involvement were more frequent with proteinase 3 (PR3) antibodies, whereas peripheral neuropathy was more frequent with myeloperoxidase (MPO) antibodies. When the disease was severe at diagnosis, the HR for mortality was 10.44. When induction treatment was not given in accordance with the guidelines, the HR for mortality was 4.00. For maintenance treatment, the HR was 5.49 for mortality and 2.48 for relapse. AAV classification is difficult because many patients had neither specific clinical data nor distinctive histological features of a single CHCC definition. A structured clinical assessment of patient severity is the best tool to guide the management of AAV.
Subject(s)
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/classification , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/pathology , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/physiopathology , Mortality , Aged , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/immunology , Antibodies, Antineutrophil Cytoplasmic/immunology , Churg-Strauss Syndrome/classification , Churg-Strauss Syndrome/immunology , Churg-Strauss Syndrome/pathology , Churg-Strauss Syndrome/physiopathology , Epistaxis/immunology , Epistaxis/pathology , Epistaxis/physiopathology , Eye Diseases/immunology , Eye Diseases/pathology , Eye Diseases/physiopathology , Female , Gastrointestinal Diseases/immunology , Gastrointestinal Diseases/pathology , Gastrointestinal Diseases/physiopathology , Granulomatosis with Polyangiitis/classification , Granulomatosis with Polyangiitis/immunology , Granulomatosis with Polyangiitis/pathology , Granulomatosis with Polyangiitis/physiopathology , Humans , Hypertension/immunology , Hypertension/pathology , Hypertension/physiopathology , Kidney Diseases/immunology , Kidney Diseases/pathology , Kidney Diseases/physiopathology , Kidney Failure, Chronic/physiopathology , Lung Diseases/immunology , Lung Diseases/pathology , Lung Diseases/physiopathology , Male , Microscopic Polyangiitis/classification , Microscopic Polyangiitis/immunology , Microscopic Polyangiitis/pathology , Microscopic Polyangiitis/physiopathology , Middle Aged , Myeloblastin/immunology , Peripheral Nervous System Diseases/immunology , Peripheral Nervous System Diseases/pathology , Peripheral Nervous System Diseases/physiopathology , Peroxidase/immunology , Primary Prevention , Prognosis , Proportional Hazards Models , Recurrence , Retrospective Studies , Severity of Illness Index , Sinusitis/immunologyABSTRACT
BACKGROUND Pseudomonal infection is the most common cause of malignant otitis externa (MOE), which typically affects elderly diabetic patients. Fungi are a rare cause of MOE. MOE can be life-threatening if not recognized and treated promptly. It can result in a wide spectrum of complications, including skull-base osteomyelitis, cranial nerve palsy, cerebral venous thrombosis, and brain abscess. Pseudoaneurysm formation of the intracranial vessels is a life-threatening complication of MOE that is seldom reported in the literature. CASE REPORT We report the case of a 66-year-old diabetic man with MOE who was initially treated with antipseudomonal antibiotics after negative initial culture results. His MOE resulted in a cascade of complications, including facial nerve palsy, skull base osteomyelitis, and sigmoid sinus thrombosis, and culminated in left maxillary artery pseudoaneurysm formation resulting in massive epistaxis and hemodynamic instability. Endovascular embolization resulted in a successful obliteration of the pseudoaneurysm. A subsequent functional endoscopic sinus surgical (FESS) tissue biopsy confirmed Candida glabrata as the etiological agent. The patient was successfully treated with antibiotics and antifungal and anticoagulation therapy, and was discharged home in good condition. CONCLUSIONS A high index of suspicion for the diagnosis of fungal MOE, particularly in intractable cases of MOE with negative initial cultures, should be maintained. Pseudoaneurysm formation is a life-threatening complication of MOE that is seldom reported in the literature and should be suspected in any patient with MOE who presents with epistaxis or intracranial bleeding.
Subject(s)
Aneurysm, False/surgery , Endoscopy/methods , Maxillary Artery/surgery , Otitis Externa/pathology , Pseudomonas Infections/complications , Aged , Aneurysm, False/diagnostic imaging , Anti-Bacterial Agents/therapeutic use , Antifungal Agents/therapeutic use , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/diagnosis , Embolization, Therapeutic/methods , Epistaxis/etiology , Epistaxis/pathology , Humans , Male , Maxillary Artery/physiopathology , Otitis Externa/etiology , Otitis Externa/physiopathology , Pseudomonas Infections/diagnosis , Pseudomonas Infections/drug therapy , Risk Assessment , Treatment OutcomeABSTRACT
BACKGROUND: Arterial epistaxis is commonly seen in the rhinology clinic and can have a significant impact on quality of life. Previous studies have explored various therapies to address epistaxis. METHODS: Patients were treated in the outpatient clinic or operating room by microwave ablation (MWA) with a 2450-MHz cooled-shaft antenna to treat an epistaxis bleeding point. RESULTS: Of the 481 patients with arterial epistaxis, bleeding was controlled within 1 to 2 minutes and only 2 patients with recurrent bleeding required re-ablation. The shape of the thermal lesion was elliptical and it was approximately 2 mm in length, 1 mm in width, and 0.5 to 1 mm in penetration depth. Of the 481 patients, 167 (34.7%) complained of minor nasal pain on the same day of ablation. No patients complained of nasal pain or obstruction during the follow-up period. In addition, 139 (28.9%) patients showed a minor increase in rhinorrhea during the first postoperative week. Of the 481 patients, 469 (97.5%) were followed-up at 6 months with no severe MWA-related complications, such as septal perforation, synechiae formation, or orbit and brain complications. CONCLUSION: MWA is a technically feasible alternative method for patients with arterial epistaxis.
Subject(s)
Ablation Techniques , Epistaxis/surgery , Microwaves/therapeutic use , Adult , Aged , Aged, 80 and over , Epistaxis/pathology , Female , Humans , Male , Middle Aged , Nasal Surgical Procedures , Treatment Outcome , Young AdultABSTRACT
Hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal dominantly inherited disorder characterized by bleeding episodes. These episodes tend to happen spontaneously and reduce the quality of life. Patients are often unresponsive to local measures. With the pathophysiological role of angiogenesis in HHT, antiangiogenic drugs including thalidomide are used to control bleeding episodes. In our study, we evaluated 6 patients with HHT, calculating their Epistaxis Severity Score (ESS) and performing a quality of life assessment with the 36-Item Short Form Health Survey Questionnaire (SF-36), and we studied the alterations of these evaluations with thalidomide treatment. Three patients were male and three were female. Mean age was 60.50 years. No side effects were observed during the treatment period. Improvements of certain SF-36 dimensions including physical functioning, physical component summary, and mental component summary and of the ESS were observed after treatment. Thalidomide may be effective to control bleeding episodes with a reasonable tolerance profile in patients with HHT.
Subject(s)
Epistaxis/drug therapy , Immunosuppressive Agents/therapeutic use , Quality of Life/psychology , Telangiectasia, Hereditary Hemorrhagic/drug therapy , Thalidomide/therapeutic use , Adult , Aged , Epistaxis/etiology , Epistaxis/pathology , Female , Humans , Immunosuppressive Agents/pharmacology , Male , Middle Aged , Telangiectasia, Hereditary Hemorrhagic/complications , Telangiectasia, Hereditary Hemorrhagic/pathology , Thalidomide/pharmacologyABSTRACT
Most anterior epistaxis originates primarily from the Kiesselbach plexus, whereas posterior epistaxis is less common and originates from branches of the sphenopalatine artery. Risk factors include local trauma, foreign body insertion, substance abuse, neoplasms, inherited bleeding diatheses, or acquired coagulopathies. Assessment of airway, breathing, and circulation precedes identification of bleeding source, pain control, and achieving hemostasis. Management options include topical vasoconstrictors, direct pressure, cautery, tranexamic acid, nasal tampons, Foley catheters, or surgical intervention. Specialty consultation may be pursued if interventions fail. Disposition is typically to home unless posterior epistaxis or significant comorbidities exist that warrant admission.
Subject(s)
Epistaxis/therapy , Emergencies , Epistaxis/etiology , Epistaxis/pathology , HumansABSTRACT
Se presenta un caso de una paciente con pérdida de peso, congestión nasal epistaxis, aumento de volumen en cuello con disfagia a sólidos y líquidos de 1 mes de evolución. La tomografía de cuello muestra una masa de tejidos blandos en la base de cuello con erosión del esfenoides con extensión a la fosa craneal media, con erosión del clivus, el esfenoides y la silla turca. El diagnostico histopatológico es un estesioneuroblastoma.
We present a case of a patient with weight loss, nasal congestion, epistaxis, increase neck volu me with dysphagia to solids and liquids of 1 month of evolution. The neck tomography shows a soft tissue mass at the base of the neck with erosion of the sphe noid with extension to the middle cranial fossa, with erosion of the clivus, the sphenoid and the sella turcica. The histopathological diagnosis is an esthesioneuroblastoma.
Subject(s)
Humans , Female , Adult , Paranasal Sinus Neoplasms/diagnostic imaging , Epistaxis/pathology , Nasal Cavity/pathology , Carcinoma, Squamous Cell/diagnostic imaging , Deglutition Disorders/diagnosis , Skull Base Neoplasms/diagnostic imaging , Ethmoid Bone/pathology , Meningioma/diagnostic imagingABSTRACT
BACKGROUND: Epistaxis is the most prevalent ENT emergency and a significant burden on ENT services. Our objective was to study the incidence and outcomes of patients presenting with epistaxis at a major teaching hospital. METHODS: A retrospective descriptive study of 721 patients, who presented with epistaxis over a 1-year period, was carried out. Data collected was analysed using SPSS software version 20. RESULTS: Of the 721 patients, initial treatment consisted of nasal cautery (298), nasal packing (200), or no treatment (223). Fifty-nine patients were admitted. The mean age of admitted patients was 66.8 years and the male to female ratio was 2:1. 69.5% had hypertension and 78% used an antiplatelet/anticoagulation medication. The majority of admitted and return patients were out of hours referrals from ED and the mean admission duration was five nights. Surgical treatment for intractable epistaxis included arterial ligation or endovascular embolisation. Successful treatment was defined as no recurrent epistaxis following pack removal or no readmission with epistaxis within 24 h of hospital discharge. Six hundred forty-four patients had successful treatment. CONCLUSION: More return and admitted patients presented at out-of-hours times with less clinical staff on site. Most non-admitted patients received no treatment. These factors possibly lead to increased stress on the ENT casualty service. Cautery and nasal packing are the most common treatment modalities in first-time and admitted patients yet result in considerable rates of representation.
Subject(s)
Cautery/methods , Epistaxis/etiology , Aged , Epistaxis/pathology , Epistaxis/therapy , Female , Hospitals, Teaching , Humans , Male , Middle Aged , Retrospective Studies , Treatment OutcomeSubject(s)
Epistaxis/etiology , Granuloma, Pyogenic/pathology , Pregnancy Complications/pathology , Adult , Epistaxis/pathology , Female , Granuloma, Pyogenic/complications , Granuloma, Pyogenic/diagnostic imaging , Humans , Nasal Septum/diagnostic imaging , Nasal Septum/pathology , Pregnancy , Pregnancy Complications/diagnostic imagingABSTRACT
BACKGROUND: Use of reliable grading scores to measure epistaxis severity in hereditary hemorrhagic telangiectasia (HHT) is essential in clinical routine and for scientific purposes. For practical reasons, visual analog scale (VAS) scoring and the Epistaxis Severity Score (ESS) are widely used. VAS scores are purely subjective, and a potential shortcoming of the ESS is that it is based on self-reported anamnestic bleeding data. The aim of this study was to validate the level of correlation between VAS scores, the ESS, and actual bleeding events, based on detailed epistaxis diaries of patients. METHODS: Records from daily epistaxis diaries maintained by 16 HHT patients over 112 consecutive days were compared with the monthly ESS and daily VAS scores in the corresponding time period. The Spearman rank correlation coefficient, analysis of variance models, and multiple R2 measures were used for statistical analysis. RESULTS: Although the ESS and VAS scores generally showed a high degree of correlation with actual bleeding events, mild events were underrepresented in both scores. CONCLUSIONS: Our results highlight the usefulness of the ESS as a standard epistaxis score in cohorts with moderate to severe degrees of epistaxis. The use of detailed epistaxis diaries should be considered when monitoring patients and cohorts with mild forms of HHT.
Subject(s)
Epistaxis/pathology , Medical Records , Telangiectasia, Hereditary Hemorrhagic/pathology , Adult , Aged , Epistaxis/etiology , Female , Humans , Male , Middle Aged , Severity of Illness Index , Telangiectasia, Hereditary Hemorrhagic/complications , Visual Analog ScaleSubject(s)
Endoscopy/methods , Epistaxis/diagnosis , Epistaxis/pathology , Humans , Male , Middle Aged , Nasal CavityABSTRACT
Endovascular particle embolization is a common procedure with a relatively safe profile. We report here four cases in which cranial nerves, skin and mucosal ischemic complications occurred with the use of hydrogel microspheres (250-500 µm in size). Given the compressibility and higher penetration potential of microsphere particles compared with polyvinyl alcohol particles of similar size, we suggest oversizing hydrogel microsphere particles for head and neck embolizations.