What are the symptoms of a nasal septal hematoma?

Nasal Septal Hematoma Symptoms

Nasal septal hematoma presents with nasal obstruction, pain, and external nasal swelling as its primary symptoms, requiring urgent recognition and treatment to prevent serious complications including septal necrosis and potential intracranial infections. 1, 2

Key Clinical Manifestations

Primary Symptoms

• Nasal obstruction/breathing difficulty - Often bilateral and significant 1, 2
• Nasal pain and discomfort - Typically described as pressure or fullness 1
• External nasal swelling - Visible swelling along the nasal ridge 1
• Tenderness - Pain on palpation of the nose 1

Secondary Symptoms

• Nasal septal swelling - Characteristic finding of bulging of the nasal septum that may occlude both nasal passages 1
• Purulent rhinorrhea - May develop if the hematoma becomes infected 2
• Fever - Present in cases of infected hematoma/abscess formation 2
• Nasal dorsal deformity - Can occur as a presenting symptom or develop later 2
• Epistaxis - Bleeding from the nose may be present in some cases 2

Physical Examination Findings

Critical Findings on Examination

• Bilateral nasal septal swelling - Pathognomonic finding of a fluctuant, boggy swelling of the nasal septum, often obstructing both nasal passages 1
• Erythema - Redness of the nasal mucosa or external nose in infected cases
• Tenderness on palpation - Both of the external nose and the septal swelling 1

Risk Factors and Etiology

Common Causes

• Nasal trauma - Most common cause, especially in children and young adults 3
• Spontaneous development - Can occur without identifiable trauma (65.6% in one study) 3
• Upper respiratory infections - May predispose to spontaneous hematoma formation 1
• Hematological disorders - Rare association with conditions like leukemia 4

Complications if Untreated

Serious Sequelae

• Septal cartilage necrosis - Due to separation of mucoperichondrium from cartilage, interrupting blood supply 2, 5
• Nasal deformity - Including saddle nose deformity from cartilage destruction 2, 5
• Abscess formation - Infected hematomas can develop into abscesses 1
• Intracranial infections - Life-threatening complications including meningitis and brain abscess 3
• Death - Reported in cases with progression to intracranial infection 3

Diagnostic Approach

Recommended Evaluation

• Anterior rhinoscopy - Essential first step to visualize the septal swelling 6
• Nasal endoscopy - May be needed for better visualization and to rule out other pathologies 6
• Imaging - Contrast-enhanced CT of the maxillofacial region can confirm diagnosis and evaluate for complications 1

Clinical Pearls

• Nasal septal hematoma is a medical emergency requiring prompt diagnosis and treatment
• The classic finding is bilateral, boggy swelling of the nasal septum
• Must be differentiated from other causes of nasal obstruction
• Untreated septal hematoma can progress to abscess formation with potential life-threatening complications
• Surgical drainage is the definitive treatment to prevent cartilage necrosis and subsequent deformity 1, 2, 5
• Early recognition is critical as mortality has been reported in cases progressing to intracranial infection 3

Remember that nasal septal hematoma can occur spontaneously, especially in adults, and not all cases have a clear history of trauma 3. Any patient presenting with sudden onset of nasal obstruction and pain should be evaluated for this condition.