We report two cases of patients who presented to the Emergency Room (ER) with a history of recurrent epistaxis. Conservative treatment was provided to both patients and the most common causes of bleeding were excluded. Patients underwent radiological examinations that revealed the presence of an Intracavernous Carotid Artery Aneurysm (ICAA) extending into the sphenoid sinus through the erosion of postero-lateral bony wall. Aneurysms rupture caused massive nasal bleeding. The purpose of our case report is to illustrate as a very common symptom like epistaxis, in a small number of cases can be underestimated: rare and severe causes of nasal bleeding, as ICAA, should therefore always be considered in the differential diagnosis.
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