A silent vascular mimicker of Sinonasal disease: Nasal cavity angioma presenting with progressive epistaxis and obstruction

Abstract

Nasal cavity angiomas are rare benign vascular lesions arising from the sinonasal mucosa, most commonly represented by lobular capillary hemangiomas. Although histologically benign, these lesions may cause significant morbidity due to their marked vascularity and propensity for recurrent epistaxis. Clinically, patients typically present with unilateral nasal obstruction and intermittent or profuse epistaxis, often leading to diagnostic delay or misdiagnosis as inflammatory or neoplastic sinonasal disease. Endoscopic examination usually reveals a well-circumscribed, reddish to purplish, polypoid mass that bleeds easily on contact. Cross-sectional imaging, particularly contrast-enhanced computed tomography and magnetic resonance imaging, plays a pivotal role in lesion characterization, assessment of local extension, and exclusion of differential diagnoses, including malignant tumors. Definitive diagnosis relies on histopathological examination, which demonstrates proliferating capillary-sized vessels arranged in a lobular architecture beneath intact respiratory epithelium. Complete endoscopic surgical excision remains the treatment of choice, offering excellent visualization, effective hemostasis, and low recurrence rates when the lesion's implantation base is adequately addressed. Early recognition of nasal angiomas is essential to ensure prompt management, avoid unnecessary biopsies with hemorrhagic risk, and achieve favorable functional and clinical outcomes. We report the case of a 25-year-old female patient with no significant past medical history who presented with progressively worsening nasal obstruction over a 6-month period. Comprehensive clinical assessment, complemented by appropriate laboratory investigations, supported the diagnosis of a nasal cavity angioma. Early recognition and timely surgical intervention are crucial to achieving favorable clinical outcomes and reducing the risk of recurrence.