Type:
Educational Exhibit
Keywords:
Multicentre study, Not applicable, Neoplasia, Haematologic diseases, Foreign bodies, Imaging sequences, Diagnostic procedure, PET-CT, MR-Diffusion/Perfusion, CT-High Resolution, Vascular, Head and neck, Anatomy, Head and Neck
Authors:
E. Marín Diez1, S. Strauss2, E. YLLERA CONTRERAS3, E. M. Marco De Lucas4, C. D. Phillips2; 1Santander/ES, 2New York/US, 3BURGOS/ES, 4Santander, Ca/ES
DOI:
10.26044/ecr2020/C-05136
Background
EPIDEMIOLOGY
- Epistaxis is one of the most common emergencies in the ear, nose, and throat (ENT) department.
- Epistaxis presents a bimodal age distribution, affecting individuals aged 2-10 years and aged 50-80 years.
- Peak incidence occurs among patients older than 70.
- Epistaxis may induce significant morbidity, particularly in the elderly and those with coexisting cardiovascular disease.
ANATOMY
Arterial Anatomy Relevant to Epistaxis
ECA branches:
- Internal maxillary artery --> Sphenopalatine and Greater palatine arteries.
- Facial artery --> Superior labial artery.
ICA branches:
- Ophthalmic artery --> Anterior and Posterior ethmoidal arteries.
Fig. 1
![](https://epos.myesr.org/posterimage/esr/ecr2020/154587/media/844392?maxheight=300&maxwidth=300)
Fig. 1: Anatomy.
Fig. 2
![](https://epos.myesr.org/posterimage/esr/ecr2020/154587/media/844394?maxheight=300&maxwidth=300)
Fig. 2: Anatomy: illustrations and angiograms.
ETIOLOGIC FACTORS
Epistaxis may be further classified as primary or secondary:
- Primary causes of epistaxis are often idiopathic and arise spontaneously (85% of all events).
- Epistaxis may also be secondary to an identifiable cause.
- Trauma.
- Allergic rhinitis and chronic rhinosinusitis --> higher incidence of epistaxis.
- Inherited bleeding diatheses (hemophilia and von Willebrand disease) and acquired coagulopathies.
- Hereditary hemorrhagic telangiectasia.
- Connective tissue and inflammatory disorders.
- Numerous medications, including anticoagulants --> increase the risk for epistaxis.
Pathologic factors unique to children and adolescents must be considered:
- Epistaxis in infants and toddlers merits consideration of nonaccidental trauma or hematologic disorder.
- Rhabdomyosarcoma is the most common pediatric sinonasalmalignancy; in addition to presenting with epistaxis, this lesion can spread to adjacent sites, including the orbit, skull base, and elsewhere in the head and neck region.
- JNA presents exclusively in adolescent boys.