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Unusual cause of recalcitrant epistaxis
  1. Gaurav Khatri1,
  2. Anup Singh1,2,
  3. Anshu Mahajan3 and
  4. Kumud Kumar Handa1
  1. 1Department of Otorhinolaryngology and Head & Neck Surgery, Medanta – The Medicity, Gurugram, Haryana, India
  2. 2Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
  3. 3Department of Neurointervention Surgery, Medanta – The Medicity, Gurugram, Haryana, India
  1. Correspondence to Anup Singh; anoop.aiims1{at}


Nosebleeds are among the most familiar presentations to the emergency department as well as otorhinolaryngologic outpatient services. Bleeding from nasal septal branches of the anterior ethmoid artery (AEA) is common and can be effectively controlled endoscopically. However, the bleeding from a pseudoaneurysm involving the nasal septal branches of AEA is extremely rare and can be troublesome to control using endoscopic methods. We report an adult patient presenting with profuse nasal bleeding postroad traffic accident due to the formation of AEA septal branch pseudoaneurysm. The patient required repeated nasal packing, and the diagnosis was revealed using digital subtraction angiography. Since profuse active bleeding precluded endoscopic visualisation, an external approach had to be adopted to ligate the AEA to control the bleeding. We discuss the management options and nuances for this rare cause of the troublesome nasal bleeding.

  • ear
  • nose and throat
  • trauma
  • interventional radiology
  • otolaryngology / ENT

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  • Contributors Conception and design: AS and GK. Acquisition of data/analysis and interpretation of data: AS, GK, AM

    and KKH. Drafting the article/ revising it critically for important intellectual content: AS, GK, AM and KKH. Final approval of the version to be published: AS, GK, AM and KKH.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.