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Clinical Challenge
Pathology
November 2015

An Elderly Woman With Left-Sided Acute Epistaxis

Author Affiliations
  • 1Department of Pathology, Mount Sinai Health System, St. Luke's-Roosevelt Hospital and Beth Israel Medical Centers, New York, New York
  • 2Rhinology and Endoscopic Sinus Surgery, Beth Israel–Mount Sinai School of Medicine, New York, New York
  • 3Otolaryngology–Head and Neck Surgery, Beth Israel–Mount Sinai School of Medicine, New York, New York
  • 4Department of Pathology, Mount Sinai Health System, Beth Israel Medical Centers, New York, New York
JAMA Otolaryngol Head Neck Surg. 2015;141(11):1019-1020. doi:10.1001/jamaoto.2015.2193

A woman in her 70s presented with a 4-day history of new-onset, left-sided acute epistaxis described as episodes of bright red bleeding and clotting from the left anterior nare, occurring multiple times per day, lasting minutes each time, and stopped with pressure. She denied other sinonasal symptoms, history of epistaxis, nasal trauma, or surgery. Clinical evaluation revealed a soft-tissue mass filling the left nasal cavity and based on the mucosal surface of the anterolateral nasal vestibule. Noncontrast paranasal sinus computed tomography showed a 1.2 × 0.8-cm ovoid soft-tissue mass opacifying the posterior aspect of the left nasal vestibule (Figure, A, arrowhead). Endoscopic excision under local anesthesia was performed to remove a broad-based soft-tissue mass from the left nasal vestibule mucosa with a cuff of grossly healthy submucosa. A tissue specimen was biopsied (Figure, B-D). The patient had an uneventful postoperative course, and her epistaxis symptoms were resolved at the 5-month follow-up.

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