Pyogenic granuloma, also known as lobular capillary hemangioma, is a benign vascular lesion that grows rapidly on the skin or mucous membranes of the head and neck region. The oral cavity is the most common site for mucosal lesions, and the nasal septal pyogenic granuloma is a rare occurrence, presenting as a solitary red exophytic papule that bleeds easily. It is more common in the third decade of life with a female predominance. While its pathogenesis remains unknown, it is commonly associated with hormonal changes during pregnancy or oral contraceptive use, nasal trauma, and systemic or local infections. Recurrent epistaxis accompanied by nasal obstruction is the most common symptom of nasal septal pyogenic granuloma. Although there is no standardized treatment approach, surgical excision is the mainstay treatment. A 71-year-old male patient without known systemic disease presented to our emergency department for on-and-off right-sided epistaxis. Nasal packing with a Foley catheter balloon and Vaseline gauzes for 72 hours were used for hemostasis. After removal of the Foley catheter and Vaseline gauzes, nasopharyngoscopy revealed a bulging mass arising from the posterior end of the right nasal septum and extending into the nasopharynx. The mass was completely excised with endoscopy assistance under general anesthesia, and the wound bed was cauterized to achieve hemostasis. The pathology report disclosed pyogenic granuloma. Pyogenic granuloma rarely appears on the posterior nasal septum near the choana, and growths in this location can be mistaken for nasopharyngeal tumors. Additionally, the clinical symptoms of pyogenic granuloma may resemble those of nasopharyngeal carcinoma. Moreover, this patient lacked the typical risk factors associated with pyogenic granuloma, which further complicated the diagnostic process. Therefore, we present this case report to share the challenges we encountered in the diagnostic process while distinguishing it from nasopharyngeal cancer. (J Taiwan Otolaryngol Head Neck Surg 2023; 58:157-162)
