Nosebleeds
I believe many people have experienced it
If a nose bleeds when I was a child
the folks will resort to the "ten Eight kinds of martial arts"
Raise your head (wrong) Stuff the paper and raise your hands to apply a towel
Come and stop the bleeding
The bleeding has stopped
The cause of bleeding is often left unexplained
How serious is nose bleeding?
It may be a tumor coming to your door!
No, 11-year-old Huzhou boy Haohao (pseudonym)
and 13-year-old Shaoxing boy Mingming (pseudonym)
were both hit!
Experts from the Department of Otolaryngology at the First Affiliated Hospital of Zhejiang University School of Medicine emphasized:
The weather is dry in winter, and the nasal mucosa is particularly fragile
But for repeated nasal congestion, Nose bleeding should not be taken lightly!
"Doctor, there was a lot of blood in my son's nose at that time. He pressed his nose with a towel and blocked his nostrils with a tissue. The bleeding couldn't be stopped. The bleeding continued. The blood flowed from the nose into the throat and was on the ground. Vomiting a large pool of blood, it was scary..." Recently, Mr. Zhang took his 11-year-old son Haohao to the outpatient clinic of Chief Physician Chen Haihong, deputy director of the Department of Otorhinolaryngology at the First Hospital of Zhejiang University, to explain his condition anxiously. They had visited two hospitals before, but they still couldn't find out the cause of Haohao's nosebleeds.
Repeated nasal congestion and nosebleeds turned out to be a tumor
During the summer vacation of 2019, they found that Haohao had severe nasal congestion when sleeping at night, and even snored and snored. He could only breathe through his mouth and seemed to be unable to breathe, so the couple took Haohao to the local hospital for treatment. After a series of examinations such as nasal CT, Haohao was diagnosed with "sinusitis". After receiving oral cephalosporins, Chinese patent medicines, and nasal sprays, his nasal congestion and runny nose were slightly relieved, but the nasal congestion on the right side persisted. There is no obvious improvement.
In the past four months, Haohao's right nasal cavity began to bleed from time to time. Although the amount of bleeding was not much, the blood still made Mr. Zhang and his wife vigilant. They took Haohao to a tertiary hospital in the province. When he went to the hospital, a CT scan of the lateral nasopharynx and sinuses showed that Haohao had "nasopharyngeal mass and sinusitis." During his hospitalization, Haohao had the scene of vomiting blood at the beginning of the article, and his hemoglobin dropped from 115g/L to 95g/L, and he was bleeding. The amount was 400ml. Since the hospital was unable to make a clear diagnosis and provide symptomatic treatment, Haohao was urgently transferred to the Department of Otolaryngology at the Zhijiang Campus of the First Hospital of Zhejiang University.
After treating Haohao, Chief Physician Chen Haihong, deputy director of the Department of Otolaryngology, found a dark red smooth mass in his right nasal cavity. After communicating with Mr. Zhang, Haohao performed sinus CT + three-dimensional reconstruction, nose After the enhanced MR examination of the pharynx, Haohao was diagnosed with "nasopharyngeal fibroangioma". The tumor was about the size of a slightly compressed table tennis ball (5.2*3.0cm), occupying the back end of the nasal cavity and nasopharynx. part, protruding into the sphenoid sinus and pterygopalatine fossa. "This tumor is close to the internal maxillary artery and has a rich blood supply. It is prone to severe bleeding when touched, and there are great surgical risks." Chief physician Chen Haihong said that children with tender skin and nasal mucosa erosion are often considered to have sinusitis. The missed diagnosis must be accurately determined by combining nasal endoscopy, sinus CT and nasal MR. After a large discussion in the department, the team decided to embolize Haohao first to reduce the blood supply to the tumor, and then perform surgery.
On November 8, the team of Chief Physician Peng Zhiyi of the Radiology Department performed right external carotid artery angiography + embolization under local anesthesia on Haohao. The next day, Chief Physician Chen Haihong performed the surgery and used a plasma knife to block the tumor-feeding artery under nasal endoscopy. The entire tumor was completely removed in less than 2 hours. There was very little bleeding during the operation. After pathological examination, the results were consistent with the nasal cavity. Angiofibroma. Fortunately, the tumor was benign. After the operation, Haohao recovered well. He no longer had nasal congestion or nosebleeds, and he no longer held his breath while sleeping. On the 4th day after the operation, Mr. Zhang and Haohao were safely discharged from the hospital.
This type of tumor is especially prevalent in adolescent boys
Coincidentally, the 13-year-old boy Mingming from Shangyu, Shaoxing, also encountered a similar situation to Haohao, with constant nasal congestion and repeated nosebleeds. After poor treatment results at a local hospital in Shaoxing, he was referred to the Otolaryngology Department of the First Hospital of Zhejiang University. After detailed examination, it was found that Mingming also suffered from "nasopharyngeal fibroangioma", and the tumor destroyed the bone at the base of his skull. At this time, Mingming's bilateral nasal cavities and nasal passages were filled with tumors, and he could only breathe through his mouth.
Chief physician Chen Haihong during surgery.
On November 14, Chief Physician Chen Haihong performed the surgery, and Deputy Chief Physician Cheng Kejia assisted, a nasal-skull base nasopharyngeal fibroangioma resection was performed through nasal endoscopy, and the obviously huge tumor was successfully removed.
Chief physician Chen Haihong introduced that nasopharyngeal angiofibroma is one of the common benign tumors in the nasopharynx, adjacent to important tissue structures such as the skull base and orbit. “Although benign, it is a locally aggressive tumor that is destructive and invasive to surrounding tissue and even bone.
"She introduced that nasopharyngeal angiofibromas can compress and absorb bone, invade the orbits, sinuses, etc., or even penetrate deep into the brain. Because the tumor is composed of blood vessels, it is prone to massive bleeding, causing serious consequences and even life-threatening consequences. The mechanism of this disease is currently unclear, and its onset may be related to hormone levels and genetic factors. It often occurs in young men aged 10-25, so it is also called "male adolescent hemorrhagic nasopharyngeal angiofibroma" (JNA). ).
Its main symptoms are:
1. Nasal obstruction: unilateral or bilateral nasal congestion, progressive nasal congestion, which may be accompanied by thick runny nose, nasal sounds, snoring, etc.
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2. Bleeding: paroxysmal nasal or oral bleeding, the amount of bleeding may be large or small.
3. Other symptoms: tumor invades the pterygopalatine fossa, posterior wall of the maxillary sinus, and infratemporal fossa. , orbit and compression of the Eustachian tube and pharyngeal opening can cause cheek bulge, tinnitus, auricularia, hearing loss, dry eye syndrome, exophthalmos, limited movement, vision loss and visual field damage, external nose deformity, headache and cranial nerve damage. Symptoms such as paralysis.
Nose bleeding may also be caused by these diseases.
“This disease is easily missed or misdiagnosed! "Chief physician Chen Haihong introduced that nasopharyngeal fibroangioma accounts for less than 0.5% of head and neck tumors and accounts for 1/16,000 of inpatients in the otolaryngology department.
Parents and young men, for unilateral or Bilateral progressive nasal obstruction, paroxysmal nasal or oral bleeding should be particularly vigilant, and it is highly suspected to be "male adolescent hemorrhagic nasopharyngeal angiofibroma". Once the tumor grows, close to or destroys important structures of the skull base, the risk of surgery will be greatly increased. It is difficult and risky, so early detection and diagnosis are crucial.
In addition, nosebleeds may also be associated with rhinitis, trauma, nasal septum deviation, various tumors, hypertension, chronic bronchitis, and emphysema. , blood disease, liver disease, and kidney disease. So what should you do if you have a nosebleed?
1. Stay calm and try not to tilt your head back. This will not stop the bleeding, but will only cause it to bleed. Blood flowing into the throat can easily irritate the trachea and cause suffocation; there is no scientific basis for raising your hands to stop bleeding when you have a nosebleed!
2. Relax your whole body. When the amount of nosebleed is small, sit down and use your fingers. Press the nose on the bleeding side for 5-10 minutes to stop bleeding, and breathe through your mouth.
3. Use a towel soaked in cold or ice water to apply to the forehead, root of the nose, neck and other parts to constrict blood vessels and reduce blood pressure. Bleeding.
4. If the above methods fail to stop the bleeding, you should go to the hospital as soon as possible to seek treatment.
Arrangements for expert clinics in the First Hospital of Zhejiang University