Intractable Anemia: A Case of Bleeding Nasal Cavernous Hemangioma

Abstract

Cavernous haemangioma of the nose is rare, but when it occurs it usually presents with severe epistaxis. This nasal pathology is mostly seen in adult patient patients. Standard approach to dealing with such haemangiomas is surgical resection. A 30-year-old woman presented to General Physician with history of haemoptysis, haematemesis and weakness. She was admitted for investigation of her severe anaemia. On examination there was no obvious source of bleeding in the mouth or oropharynx, and Upper GI endoscopy did not reveal any pathology. She was referred to us after a trivial episode of epistaxis. Anterior and posterior rhinoscopy did not reveal any abnormality. Her extreme anxiety made indirect laryngoscopy and post-nasal space examination difficult but no obvious abnormality was seen. Diagnostic nasal endoscopy was done, and a small haemangiomatous mass was found in the postero superior part of inferior turbinate. Excision of the mass was done under local anaesthesia and sent for histopathological evaluation. The mass on histopathology came out to be Cavernous haemangioma.

Endoscopic Nonembolized Resection of an Extensive Sinonasal Cavernous Hemangioma: A Case Report and Literature Review

“…15 Since then, only sporadic cases have been reported in adults, totaling <40 sinonasal cavernous hemangiomas. 6–14,17,23–25 Within the sinonasal region, the most commonly reported sites include the nasal septum, nasal vestibule, inferior nasal turbinates, and maxillary sinus. 15,18 Capillary hemangiomas typically present at the nasal septum, whereas cavernous hemangiomas more often occur at the lateral nasal wall.…”

“…Indeed, to the best of our knowledge, Ͻ40 cases of sinonasal cavernous hemangiomas have been reported in adulthood since 1959. [5][6][7][8][9][10][11][12][13][14][15][16][17] Typically, cavernous hemangiomas are associated with the lateral wall of the nasal cavity or with the inferior turbinate. 5,15,18 To date, there are no publications of a soft tissue sinonasal cavernous hemangioma that extends up to the anterior skull base (ASB).…”

Hemangioma capilar lobular nasal del cornete medio: una causa rara de epistaxis recurrente

“…Sin embargo, son aun más raras las lesiones localizadas en el cornete medio, por tanto, su consideración como un diagnóstico diferencial de epistaxis recurrente es relevante para el otorrinolaringólogo. 4 La presentación clínica depende de la localización de la tumoración, pero en general es epistaxis recurrente, obstrucción nasal y la visualización de la masa, como se ha documentado en las diferentes series de casos, [5][6][7] aunque puede ser variada dependiendo de sitios raros ocultos. El diagnóstico se ve apoyado por la exploración física, la endoscopia nasal y los estudios de imagen como resonancia magnética o tomografía computarizada con contraste.…”

“…Si bien los hemangiomas nasales 2 son lesiones benignas, que en ubicaciones habituales no presentan una ruta diagnóstico-terapéutica compleja para el clínico, cuando se presentan en ubicaciones no habituales, es pertinente protocolizar adecuadamente al paciente. 7 Sarkar y colaboradores 4 presentaron el caso en el que el paciente presentaba anemia por una causa no detectable, hasta que se realizó el diagnóstico de un hemangioma en la porción posterior del cornete inferior y se resecó, lo que resolvió la causa.…”