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A 15-year-old boy presented with right-sided anterior epistaxis after undergoing anterior packing at an outside hospital. He had experienced approximately 4 episodes of right-sided epistaxis per year for 10 years. He had no history of antecedent trauma, nasal surgery, or bleeding diatheses and no facial numbness or pressure. His medical and family histories were noncontributory. The patient had age-appropriate vital signs, and the results of examination of his eyes, face, oral cavity, larynx, neck, and cranial nerves were normal. After his nasal packing was removed, he developed brisk anterior bleeding from the right side. The bleeding was localized to the lateral nasal wall, near the middle meatus. No discrete mass was seen, but the site appeared purpuric. Hematologic laboratory tests showed no abnormalities. Computed tomographic and magnetic resonance imaging was performed (Figures 1, 2, and 3).
Lee LN, Shin JJ, Kunst MM, Hsu M, Holbrook EH, Keamy DG. Radiology Quiz Case 3. Arch Otolaryngol Head Neck Surg. 2011;137(4):406. doi:10.1001/archoto.2011.42-a