Some Causes of Epistaxis

Common

Drying of the mucosa (eg, in cold weather)

Usually visibly dry during examination

Physical examination alone

Local trauma (eg, nose blowing, picking, blunt impact)

Apparent by history

Physical examination alone

Less common

Arteriosclerosis

Usually in older patients

Physical examination alone

Coagulopathy or thrombocytopenia

History of prior epistaxis or other bleeding sites, such as gingiva

CBC with platelet count, PT/PTT

Foreign bodies (mainly in children)

Often recurrent epistaxis with a malodorous discharge from one nostril

Physical examination

Rigid endoscopy

Illicit drug use (eg, cocaine use)Illicit drug use (eg, cocaine use)

Positive history of using illicit drugs, nasal septal perforation on exam (in extreme cases)

History and physical examination alone

Urine toxicology screen

Local infections (eg, vestibulitis, rhinitis)

Crusting in the nasal vestibule, often with local pain and dry mucosa

History and physical examination

Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)

Telangiectasias on the face, lips, oral and nasal mucosa, and tips of the fingers and toes

Positive family history

History and physical examination

Genetic testing

Skin biopsy

Septal perforation

History of trauma (surgery or injury), certain chronic infections, or cocaine useHistory of trauma (surgery or injury), certain chronic infections, or cocaine use

Visible during examination

History and physical examination

Systemic disorders (eg, advanced HIV infection, liver disease)

Presence of known disease

Mucosal erosions and hypertrophy

History and physical examination

Tumor (benign or malignant) of the nasopharynx or paranasal sinuses

Mass seen within the nose or nasopharynx

Bulging of the lateral nasal wall

CT