Wednesday, May 29, 2019


Q: 34 year old male recent immigrant from China is admitted via ED to ICU where he presented with massive epistaxis without any provocation. Emergent Ear-Nose-Throat service was obtained in ER to control the hemorrhage. What is the underlying concern?

Answer; Nasopharyngeal cancers

 Epistaxis can be either from anterior or posterior vessels. Anterior nosebleeds are the most common and usually benign. Posterior nose-bleeds can be potentially life-threatening, and be a sign of major clinical disease like carotid artery aneurysm or neoplasm.

Nasopharyngeal cancers are common in patients of Chinese origin and can result in massive bleeding.



1. Liu JK, Gottfried ON, Amini A, Couldwell WT. Aneurysms of the petrous internal carotid artery: anatomy, origins, and treatment. Neurosurg Focus 2004; 17:E13. 

2. Chen D, Concus AP, Halbach VV, Cheung SW. Epistaxis originating from traumatic pseudoaneurysm of the internal carotid artery: diagnosis and endovascular therapy. Laryngoscope 1998; 108:326. 

3. CHENG HER. Nasopharyngeal Cancer and the Southeast Asian Patient Am Fam Physician. 2001 May 1;63(9):1776-1783.

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