Dear rasinkar,
If your patient has a history of skull base fracture or severe trauma of the
head, you might consider a caritico-cavernous aneurysm. This can be seen on
1 mm CT-scan of the skull base. Bleeding occurs through the recessus
sphenoethmoidales and is therefore difficult to locate.
With kind regards
Henk Blom

rasinkar wrote:

>  A male patient aged 23 yrs. visited e.n.t. O.P.D. with h/o occassional
> post nasal bleeding since 6 yrs. The interval of attack was varying
> between 15 days to 4 months .Initially he used to get mild rhinorrhea
> later with mild cough . He used to spit out about 2-3 ml of frank blood,
> sometimes clotted blood. There is no h/o diabetes , hypertension,
> Kock's, or cough, asthama, Patient is healthy except for the symptom of
> post nasal bleeding.
> Clinical examination revealed congested nasal mucosa,hypertrophied
> terbinates, mild tenderness over frontal and temporal areas
> Investigations revealed normal blood count Hb12.8gms%,Urine is normal ,
> Bleeding time , Clotting time , Prothrombin time is normal.1994 Xray
> chest was showing pathy consolidation in the left lowr zone, which
> promptly cleared with antibiotics.X-ray P.N.S. is normal, Hiv 1&2 are
> negetive. C.T.Scan skull does not show any abnormality.Abdominal x-ray
> and Sonography did not reveal any abnormality.
> Fibreoptic Broncoscopy was normal, As the bleeding lasts for a day or
> two that too occassionally, the site of bleeding could not be diagnosed
> Can anybody give clue to the proper Diagnosis





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