01/12/2025
How To differentiate a nasal septal abscess from a hematoma?
key features to consider:
1. Clinical Presentation:
Septal Abscess:
Characterized by localized tenderness, swelling, and sometimes erythema over the septum.
The pain is usually more intense and constant.
May present with fever due to infection.
There could be purulent discharge if the abscess drains.
Septal Hematoma:
Typically presents with soft, non-tender swelling of the septum after trauma or injury.
No fever unless secondary infection occurs.
There may be bluish discoloration of the septum due to trapped blood.
The pain is usually less severe compared to an abscess.
2. Physical Examination:
Nasal Septal Abscess:
On examination, the swelling is firm and fluctuant, suggesting the presence of pus.
Pus can sometimes be aspirated if the abscess has drained.
Nasal Septal Hematoma:
The swelling is soft and fluctuant, but it does not express pus.
There may be a visible blood clot or fluid when aspirating, without any sign of infection.
3. History:
Abscess often follows infection (e.g., after a trauma with bacterial inoculation).
Hematomas are typically associated with recent trauma or blunt injury to the nose.
4. Imaging (if needed):
Nasal Septal Abscess: A CT scan or US confirm the presence of fluid collection and infection.
Nasal Septal Hematoma: Imaging may show a blood-filled cavity, but no evidence of infection.
5. Management:
Abscess: Requires drainage and typically antibiotics.
Hematoma: Requires drainage to prevent septal necrosis but may not need antibiotics unless infected.