A 16-year-old boy has recurrent unilateral epistaxis and obstruction. Imaging shows an avidly enhancing posterior nasal mass extending to the pterygopalatine fossa. What is the safest diagnostic principle?
The lesion may be highly vascular. In an appropriate clinical and radiological setting, unplanned biopsy can cause severe haemorrhage without improving initial management.
A. Use characteristic imaging and specialist skull-base assessment; avoid routine office biopsy: The lesion may be highly vascular. In an appropriate clinical and radiological setting, unplanned biopsy can cause severe haemorrhage without improving initial management.
B. Take a punch biopsy in clinic before imaging review: This risks uncontrolled bleeding.
C. Treat as allergic rhinitis because of age: The unilateral bleeding mass requires urgent structural assessment.
D. Perform simple anterior cautery only: This does not diagnose or control the underlying lesion.
E. Start anticoagulation for recurrent epistaxis: This would increase bleeding risk.
If imaging suggested a non-vascular infiltrative mass, tissue diagnosis would be planned through a different controlled route.
Draft Clinora educational material only; not official JCIE content or clinical advice.
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