Diagnostic Considerations

Recurrent epistaxis in children could be caused by a foreign body, especially if the nosebleeds are accompanied by symptoms of unilateral nasal congestion and purulent rhinorrhea. Delayed epistaxis in a trauma patient may signal the presence of a traumatic aneurysm.

Other conditions to be considered include the following:

Chemical irritants
Hepatic failure
Leukemia
Thrombocytopenia
Heparin toxicity
Ticlopidine toxicity
Dipyridamole toxicity
Trauma
Tumor

Differential Diagnoses

Allergic Rhinitis
Barotrauma
Cocaine Toxicity
Coumarin Plant Poisoning
Disseminated Intravascular Coagulation in Emergency Medicine
Emergent Treatment of Endometriosis
Nasal Foreign Bodies
Nonsteroidal Anti-inflammatory Drug (NSAID) Toxicity
Pediatric Osler-Weber-Rendu Syndrome
Rodenticide Toxicity
Salicylate Toxicity
Sinusitis (Rhinosinusitis) Imaging
Type A Hemophilia
Type B Hemophilia
von Willebrand Disease
Warfarin and Superwarfarin Toxicity

Workup

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Media Gallery

Posterior epistaxis from the left sphenopalatine artery.
Resolved posterior epistaxis after endoscopic cauterization of the left sphenopalatine artery.
Nasal speculum.
Vaseline gauze packing.
Expandable (Merocel) packing (dry).
Nasal vascular anatomy

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Author

Quoc A Nguyen, MD Associate Clinical Professor, Director, Sinus and Allergy Center, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Medical Center

Quoc A Nguyen, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, Phi Beta Kappa, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, The Triological Society, American Rhinologic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Ted L Tewfik, MD Professor of Otolaryngology-Head and Neck Surgery, Professor of Pediatric Surgery, McGill University Faculty of Medicine; Senior Staff, Montreal Children's Hospital, Montreal General Hospital, and Royal Victoria Hospital

Ted L Tewfik, MD is a member of the following medical societies: American Society of Pediatric Otolaryngology, Canadian Society of Otolaryngology-Head & Neck Surgery

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan; Ryte; Neosoma; MI10<br/>Received income in an amount equal to or greater than $250 from: Neosoma; Cyberionix (CYBX)<br/>Received ownership interest from Cerescan for consulting for: Neosoma, MI10.

Additional Contributors

Hassan H Ramadan, MD, MSc, FACS, FARS Professor and Chairman, Director of Rhinology and Allergy Center, Department of Otolaryngology-Head and Neck Surgery, Professor, Department of Pediatrics, West Virginia University School of Medicine

Hassan H Ramadan, MD, MSc, FACS, FARS is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Rhinologic Society

Disclosure: Nothing to disclose.

Epistaxis Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

References

Tables

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