Epistaxis differential diagnosis
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Editor in Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Amir Behzad Bagheri, M.D.
Overview
Many diseases can cause epistaxis. Based on patient history and physical examination we can diagnose cause of epistaxis. The challenging part is distinguish between anterior- epistaxis and posterior-epistaxis.
Differentiating Epistaxis from other Diseases
According to the following points, we can differentiate between anterior and posterior epistaxis:
- Anterior epistaxis is more common than posterior epistaxis, but posterior-epistaxis is harder to stop.
- Causes of both anterior and posterior epistaxis are almost the same.
- Bleeding from nostril usually refers to anterior-epistaxis (it can occur in heavy posterior-epistaxis too).
- Epistaxis in children is usually anterior but incidence of posterior epistaxis is more in elderly patients.
- Rhinoscopy is the best way to distinguish between anterior and posterior epistaxis, and we can't find source of bleeding with anterior rhinoscopy.
Following causes of epistaxis are the most important causes that we should differentiate them:
According to past medical history, drug history, and examinations, different causes of epistaxis can be diagnosed.[1]
In alphabetical order[2] [3]
- Alcoholism
- Allergic rhinitis
- Aortic isthmus stenosis
- Aplastic anemia
- Arteriosclerosis
- Arteriovenous malformation
- Avitaminosis C
- Bleeding septal polyp
- Chronic hepatitis
- Cirrhosis
- Coagulopathy
- Coarctation of the aorta
- Disseminated Intravascular Coagulation (DIC)
- Drugs such as aspirin, clopidogrel, coumadin, heparin, enoxaparin, bivalirudin, fondaparinux, eptifibatide, abciximab, tirofiban
- Dry climate
- Dust
- Erythrocythemia
- External trauma
- Forceful nose blowing
- Hemophilia
- Hemorrhage of Kiesselbach's area
- Infection
- Influenza
- Internal trauma
- Juvenile nasopharyngeal fibroma
- Leukemia
- Liver failure
- Malaria
- Measles
- Multiple myeloma
- Nasal diphtheria
- Nasal foreign body
- Nasal fractures
- Nasal polyps
- Nasal syphilis
- Neoplasm
- Nose picking
- Osler's disease
- Other trauma to the face
- Pancytopenia
- Postoperative
- Psittacocis
- Repeated cocaine use
- Rhinitis sicca
- Scarlet fever
- Septal deviation or perforation
- Sinus fracture
- Sinusitis
- Snakebites
- Streptococcal infection
- Telangiectasias
- Thrombocytopathy
- Thrombocytopenia
- Typhoid fever
- Uremia
- Vapors
- Vitamin K deficiency
- Von Willebrand's disease
- Waldenstrom's macroglobulinemia
- Wegener's granulomatosis
- Werlhof's disease
- Winter months
References
- ↑ Krulewitz, Neil Alexander; Fix, Megan Leigh (2019). "Epistaxis". Emergency Medicine Clinics of North America. 37 (1): 29–39. doi:10.1016/j.emc.2018.09.005. ISSN 0733-8627.
- ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
- ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X