Epistaxis: the cause found beyond the nose

Renal cell carcinoma (RCC) is a malignant disease that is often diagnosed at a metastatic stage. The head and neck represent up to 3% of the metastatic RCC, and the paranasal sinus area is one of the least involved sites. Here, we introduce the case of a 74-year-old female patient who presented with a history of traumatic nasal bleed. A cranial computed tomography scan and magnetic resonance imaging showed a fronto-ethmoidal mass with pachymeningeal involvement. A nasal biopsy from the paranasal sinuses was taken. On histopathological examination, metastatic clear cell carcinoma was the main hypothesis, which later was confirmed to be RCC on immunohistochemistry. On further radiological examination, an exophytic mass was depicted in the kidney's upper and middle pole. The patient had no renal complaints and was asymptomatic. Fronto-ethmoidal sinus is a rare site for metastatic RCC, especially in cases where the patient is asymptomatic. Early detection by keeping RCC metastasis as the differential diagnosis in such cases can lead to early treatment and improve the overall survival of the patient.

Estesioneuroblastoma Olfatorio: Presentacion De Un Caso / Oligatory Esthesioneuroblastoma: Presentation of a Case

Se presenta un caso de una paciente con pérdida de peso, congestión nasal epistaxis, aumento de volumen en cuello con disfagia a sólidos y líquidos de 1 mes de evolución. La tomografía de cuello muestra una masa de tejidos blandos en la base de cuello con erosión del esfenoides con extensión a la fosa craneal media, con erosión del clivus, el esfenoides y la si­lla turca. El diagnostico histopatológico es un estesioneuroblastoma.

We present a case of a patient with weight loss, nasal congestion, epistaxis, increase neck volu­ me with dysphagia to solids and liquids of 1 month of evolution. The neck tomography shows a soft tissue mass at the base of the neck with erosion of the sphe­ noid with extension to the middle cranial fossa, with erosion of the clivus, the sphenoid and the sella turcica. The histopathological diagnosis is an esthesioneuroblastoma.

Rendu-Osler-Weber syndrome: dermatological approach

The Rendu-Osler-Weber syndrome is a rare systemic fibrovascular dysplasia, recognized by mucocutaneous telangiectasias, arteriovenous malformations, epistaxis and family history. Recurrent bleeding, hypoxemia, congestive heart failure, portosystemic encephalopathy, and symptoms related to angiodysplasia of the central nervous system may occur. Since the treatment is based on supportive measures, early recognition is of utmost importance. This article reports the case of a 53-year-old male patient who presented telangiectasias on fingers, oral cavity and nasal mucosa for 10 years, with a history of recurrent epistaxis of varying severity since childhood. Mother, sister and daughter have similar lesions.

Amiloidosis cutánea / Cutaneous amyloidosis

Paciente masculino de 54 años de edad, quien refiere inicio de enfermedad actual en junio de 2010 cuando evidencia aumento de volumen y dolor en ambos tobillos, astenia y pérdida de peso de 20 kilogramos y fiebre. Ingresó con epistaxis profusa, lesiones descamativas, dolorosas en miembros superiores, a predominio de regiones antebraquiales y manos. Inmunoelectroforesis de Ig en suero: hipergammaglobulinemia 2494mg/100ml. Biopsia de grasa periumbilical: positiva para depósitos amiloides a tinción con rojo Cong...

Epistaxis severa en gestante de 37 semanas / Severe nose bleed in a 37 weeks pregnant woman

La epistaxis o sangramiento nasal es un episodio muy frecuente en cualquier etapa de la vida y su resolución pudiera ser espontánea, aunque a veces puede ser de mayor gravedad y poner en riesgo la vida del paciente. Numerosas causas la producen y entre ellas, la gestación; la cual conlleva a cambios fisiológicos importantes en la mucosa nasal, relacionados con los cambios hormonales producen congestión y posible sangramiento nasal. Presentamos el caso de una paciente de 25 años de edad, con embarazo de 37 semanas con sangramiento nasal severo, sin otra causa aparente, a la cual fue necesario realizarle taponamiento antero posterior y al no resolver se impone tratamiento con plaquetas, por lo que dejó de sangrar y le permitió tener un parto fisiológico. Después de 8 meses se realizaron complementarios comprobándose que la paciente no tenía una Trombopatia. Llamamos la atención sobre la importancia que reviste el estudio de las epistaxis durante el embarazo, a pesar de ser producida por cambios fisiológicos.

Epistaxis o nasal bleeding is a frequent episode in any stage of life and its solution may be spontaneous even though at times it may be of greater severity and turns out to be a risk for the patient´s life. There are numerous causes that provoke such bleedings, among them: pregnancy, caused by important phisiological changes in the nasal mucouse, leading to congestion and epistaxis. A case of a 25-year-old patient is presented. The patient is a 37-week pregnant with severe nasal bleeding. No other ethiology is associated. An anterior posterior air blocking was performed without positive results. Therefore, platelet treatment was administered controlling the bleeding and allowed the patient to have a physiological labour. After 8 months, CBC was ordered. The patient did not have any hemotologic dysfunction. The present case study underlines focusing epistaxis during pregnancy though considered physiologically normal.

Sinonasal neurogenic tumours.

Among the surgically excised or biopsied sinonasal tumours in a span of ten years, the neurogenic tumours formed 6.7% of all sinonasal tumours. They were eight in number, three schwannomas, two neurofibromas and three malignant schwannomas with occurrence in a wide age range and no gender predilection. Nasal obstruction and epistaxis were common modes of presentation with a unilateral location. The diagnosis of benign neurogenic tumours do not pose difficulty. However, malignant schwannoma should be considered when one encounters a cellular spindle cell lesion in sinonasal region.

Epistaxe como manifestaçäo da síndrome de Bernard-Soulier / Epistaxis as a manifestation of Bernard-Soulier Syndrome

Objetivo: Chamar a atençäo dos pediatras para uma causa rara de epistaxes severas de repetiçäo. Métodos: Os autoes descrevem um caso de criança com Síndrome de Bernard-Soulieur e fazem uma revisäo de relatos da Síndrome em língua inglesa existentes no MEDLINE desde 1970. Resultados: É descrito um menino de 3 anos e 3 meses, com quadro de epistaxes volumosas de repetiçäo, com importante repercussäo emodinâmica, no qual foram necessárias várias transfusöes de sangue e hemoderivados. Foram estabelecidas diversas suspeitas diagnósticas até que, pelo exame de sangue periférico, identificaram-se macroplaquetas. o diagnóstico final foi de Síndrome de Bernard-Soulieur, e procedeu-se à embolizaçäo da artéria maxilar para solucionar as epistaxes de repetiçä ...