Case Reports

Epistaxis, mass in right nostril • Dx?

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► Epistaxis
► Whitish mass in right nostril
► Normal vital signs and lab work


 

References

THE CASE

A 49-year-old woman visited our family medicine clinic because she’d had 3 episodes of epistaxis during the previous month. She’d already visited the emergency department, and the doctor there had treated her symptomatically and referred her to our clinic.

On physical examination, we noted a whitish mass in the patient’s right nostril that was attached to the nasal septum. The patient’s vital signs were within normal limits. She had a history of hypertension, depression, anxiety, gastroesophageal reflux disease, and post-traumatic stress disorder. Her medications included amlodipine-benazepril, atenolol-chlorthalidone, citalopram, clonazepam, prazosin, and omeprazole. The patient lived alone and denied using tobacco or illicit drugs, but she drank one to 2 glasses of brandy every day. She denied any past medical or family history of similar complaints, autoimmune disorders, or skin rashes.

A complete blood count, international normalized ratio, sedimentation rate, anti-nuclear antibody test, and an anti-neutrophil cytoplasmic antibody panel were normal.

THE DIAGNOSIS

We referred the patient to an ear, nose, and throat doctor for a nasal endoscopy and a biopsy, which showed granulation tissue. A maxillofacial computed tomography (CT) scan revealed a 1.44 cm x 0.8 cm polypoid soft tissue mass in the right nasal cavity adherent to the nasal septum with no posterior extension (FIGURE 1).

CT scan reveals mass attached to anterior nasal septum image
The patient underwent cauterization of the mass and was sent home with a prescription for fluticasone spray and a referral to a head and neck oncologist. Excision and biopsy of the mass revealed pyogenic granuloma (lobular capillary hemangioma) with surface ulceration (FIGURES 2 AND 3).

Lobular capillaries, when considered along with the surface ulceration with fibrous exudate and granulation tissue, are typical of pyogenic granuloma image

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