A 77-year-old man with severe epistaxis not controlled by anterior packing and who spits clots. What is the most likely source of the bleed?

A 77-year-old man with severe epistaxis not controlled by anterior packing and who spits clots. What is the most likely source of the bleed?

• A. Kiesselbach plexus
• B. Superior thyroid artery
• C. Posterior ethmoidal artery
• D. Sphenopalatine artery

Answer: (D)

Posterior epistaxis is suggested when bleeding is brisk, not controlled by anterior packing, and the patient braces with or spits out clots. The sphenopalatine artery, a branch of the maxillary artery, runs in the posterior nasal cavity and is the most common source of these posterior bleeds. Its location and the high-pressure arterial flow explain why blood often streams down the throat and can be spit out as clots, rather than only pooling at the front of the nose. In contrast, anterior bleeds from Kiesselbach’s plexus are the usual, milder nasal bleeds that respond well to anterior packing. The posterior ethmoidal artery can cause posterior bleeding but is less common than the sphenopalatine artery. The superior thyroid artery is not a typical nasal bleed source. So the most likely source here is the sphenopalatine artery.

Posterior epistaxis is suggested when bleeding is brisk, not controlled by anterior packing, and the patient braces with or spits out clots. The sphenopalatine artery, a branch of the maxillary artery, runs in the posterior nasal cavity and is the most common source of these posterior bleeds. Its location and the high-pressure arterial flow explain why blood often streams down the throat and can be spit out as clots, rather than only pooling at the front of the nose.

In contrast, anterior bleeds from Kiesselbach’s plexus are the usual, milder nasal bleeds that respond well to anterior packing. The posterior ethmoidal artery can cause posterior bleeding but is less common than the sphenopalatine artery. The superior thyroid artery is not a typical nasal bleed source. So the most likely source here is the sphenopalatine artery.