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Clinical Problem Solving
October 2013

A Man With Recurrent Right-Sided Epistaxis

Author Affiliations
  • 1New York University School of Medicine, New York
  • 2New York University Langone Medical Center, New York
  • 3Albert Einstein College of Medicine, Beth Israel Medical Center, New York, New York
JAMA Otolaryngol Head Neck Surg. 2013;139(10):1067-1068. doi:10.1001/jamaoto.2013.4397

A man in his 60s in otherwise good health was referred for a history of recurrent right-sided epistaxis that occurred every 3 to 4 years. Two previous biopsy specimens from the suspected source of the bleeding on the right inferior turbinate revealed only chronic inflammation. On fiberoptic nasal endoscopy, a submucosal mass was seen in the right nasal cavity. The inferior turbinate could not be visualized as distinct from this lesion, and there was no space seen between it and the nasal septum. Findings from the remainder of the intranasal examination and evaluation of the nasopharynx were normal. Computed tomography (CT) of the paranasal sinuses was performed for further evaluation. The scan revealed a soft-tissue mass in the right anterior nasal cavity inseparable from the inferior turbinate and nasal septum with some scalloping of bone at the piriform aperture but with no aggressive behavior (Figure, A).