A patient has had a nosebleed for a few days. He complains that it will not stop. The blood is running down the back of his throat. Which of these do you suspect to be the cause?

• A. Posterior nosebleed
• B. Choroid plexus
• C. Kesselbach's plexus
• D. Anterior nosebleed

Answer: (A)

Blood running down the back of the throat signals a posterior epistaxis. Bleeding from the posterior nasal cavity, fed by branches of the sphenopalatine artery, tends to be heavier and harder to control and often drains into the pharynx, so patients notice blood in the throat or swallowed blood. This contrasts with anterior nosebleeds, which come from Kiesselbach’s plexus on the nasal septum and usually present as a more modest bleed from the nostril that’s easier to stop with direct pressure. In this scenario, the persistent nature and the symptom of blood flowing down the throat point to a posterior source.