title: Intractable epistaxis due to isolated primary telangiectasias.
abstract: OBJECTIVE
  Epistaxis is the most common otolaryngologic emergency in the United States. Most cases are controlled with first-line measures, but intractable epistaxis can be a challenging clinical problem requiring posterior nasal packing and surgical or endovascular intervention. Bleeding from nasal telangiectasias is well known in hereditary hemorrhagic telangiectasia, but there are no reports in the literature of recurrent epistaxis due to isolated telangiectasias not associated with systemic disease. This report describes a series of cases in which intractable epistaxis due to isolated primary telangiectasias was effectively controlled with bipolar electrosurgery.
  
  
  METHODS
  We describe a patient with intractable epistaxis that had failed management with posterior packing and embolization. We also report a series of 16 cases of epistaxis, 6 of which were intractable, in adults without hereditary hemorrhagic telangiectasia who received treatment between 2009 and 2012. These cases reveal a common pattern of bleeding from telangiectasias on the anterior septum (8 cases [42%]), nasal sidewall (3 [16%]), inferior meatus (2 [10%]), posterior septum (2 [10%]), nasal floor (2 [10%]), middle turbinate (1 [5%]), and inferior turbinate (1 [5%]).
  
  
  CONCLUSIONS
  Telangiectasias not associated with systemic disease are a previously unreported source of significant nasal bleeding that, when identified endoscopically, can be treated successfully with bipolar electrosurgery rather than with more invasive and costly surgical and endovascular measures.
authors: Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee.
authors: Timothy
authors: T
authors: Stoddard
authors: Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee.
authors: Todd A
authors: TA
authors: Loehrl
authors: Department of Pathology, Medical College of Wisconsin, Milwaukee.
authors: Bryan C
authors: BC
authors: Hunt
authors: Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee.
authors: David M
authors: DM
authors: Poetker
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004564:Electrocoagulation / Q000379:methods*; D004636:Emergency Service, Hospital; D004844:Epistaxis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000473:pathology / Q000601:surgery; D009300:Nasal Septum / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013684:Telangiectasis / Q000150:complications* / Q000175:diagnosis; D016896:Treatment Outcome