Question

A 93-year-old man on aspirin presents to the ED with epistaxis. On physical exam, you note bleeding from bilateral nares and down the posterior pharynx. You are unable to visualize the source of bleeding. Which of the following vessels is most likely the source of bleeding in this patient?

A) Facial artery
B) Kiesselbach plexus
C) Labial artery
D) Sphenopalatine artery

Answer 1

The most likely source of bleeding in this 93-year-old man with epistaxis is the Kiesselbach plexus.

Step-by-step explanation:

In this 93-year-old man with epistaxis, the most likely source of bleeding is the Kiesselbach plexus. The Kiesselbach plexus, also known as Little's area, is located on the anterior part of the nasal septum and is where the branches of the ethmoidal arteries (which are branches of the internal carotid artery) anastomose with branches of the anterior ethmoidal artery, the sphenopalatine artery (a branch of the maxillary artery), and the superior labial artery (a branch of the facial artery).

The bleeding from bilateral nares and down the posterior pharynx suggests that the source of bleeding is likely in the anterior part of the nasal septum, which is consistent with a bleed from the Kiesselbach plexus. The other vessels listed in the options (Facial artery, Labial artery, and Sphenopalatine artery) are less likely to be the source of bleeding in this patient.

Therefore, the correct answer is B) Kiesselbach plexus.