Skip to main content


Log in

Clival chordoma manifesting as nasal bleeding. A case report

  • Diagnostic Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript


Chordoma is a rare cartilaginous tumor, for which bleeding presentation is unusual. We report a case of rare hemorrhaged clival chordoma, which was diagnosed correctly by magnetic resonance imaging. A 32-year-old man presented with nasal bleeding. The tumor was totally removed via a trans-sphenoidal approach, from which the surgical specimen confirmed chordoma. Epistaxis seemed to be caused by the spreading of the intratumoral hemorrhage into the sphenoid sinus. This case demonstrates the importance of an exact differential diagnostic evaluation, including chordoma, by use of modern imaging techniques for nasal bleeding.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others


  1. Asano S, Kawahara N, Kirino T (2003) Intradural spinal seeding of a clival chordoma. Acta Neurochir (Wien) 145:599–603

    Article  CAS  Google Scholar 

  2. Gardner WJ, Tuner O (1941) Cranial chordoma: a clinical and pathologic study. Arch Surg 42:411–425

    Google Scholar 

  3. Meyers SP, Hirsch WL Jr, Curtin HD, Barnes L, Sekhar LN, Sen C (1992) Chordomas of the skull base: MR features. AJNR Am J Neuroradiol 13:1627–1636

    CAS  PubMed  Google Scholar 

  4. Bartolini G (1974) Chordoma of the clivus as a cause of cerebral hemorrhage: anatomoclinical discussion of an autopsied case. Boll Soc Ital Biol Sper 50:912–918

    CAS  PubMed  Google Scholar 

  5. Franquemont DW, Katsetos CD, Ross GW (1989) Fatal acute pontocerebellar hemorrhage due to an unsuspected spheno-occipital chordoma. Arch Pathol Lab Med 113:1075–1078

    CAS  PubMed  Google Scholar 

  6. Koga N, Kadota Y, Hatashita S, Hosaka Y, Sugimura J, Sakakibara T, Takagi S (1988) A case of clivus chordoma showing hemorrhage in the posterior fossa. No Shinkei Geka 16:1417–1421

    CAS  PubMed  Google Scholar 

  7. Lee HJ, Kalnin AJ, Holodny AI, Schulder M, Grigorian A, Sharer LR (1998) Hemorrhagic chondroid chordoma mimicking pituitary apoplexy. Neuroradiology 40:720–723

    Article  CAS  PubMed  Google Scholar 

  8. Levi AD, Kucharczyk W, Lang AP, Schutz H (1991) Clival chordoma presenting with acute brain stem hemorrhage. Can J Neurol Sci 18:515–518

    CAS  PubMed  Google Scholar 

  9. Nakau R, Kamiyama H, Kazumata K, Andou M (2003) Subarachnoid hemorrhage associated with clival chordoma—case report. Neurol Med Chir (Tokyo) 43:605–607

    Article  Google Scholar 

  10. Koch O, Jecker P, Maurer J (2001) The interesting case no. 42. Differential diagnosis of epistaxis. Laryngorhinootologie 80:109–111

    Article  CAS  PubMed  Google Scholar 

  11. Godey B, Morandi X, Le Gall F, Feat S, Brassier G, Le Clech G (1999) Pituitary adenomas with infra-sellar extension into the nasopharynx. J Laryngol Otol 113:1109–1111

    CAS  PubMed  Google Scholar 

  12. Keane JR (1984) Pituitary apoplexy presenting with epistaxis. J Clin Neuroophthalmol 4:7–8

    CAS  PubMed  Google Scholar 

  13. Labagnara J Jr, Han K, Pushparaj N (1979) Epistaxis, pituitary adenoma and acromegaly. J Med Soc N J 76:191–196

    PubMed  Google Scholar 

  14. Onoda N, Kamezu Y, Takagi S, Shinohara Y, Osamura RY (1992) An autopsy case of invasive pituitary adenoma (prolactinoma) with rapid fatal clinical course due to streptococcal meningitis. Acta Pathol Jpn 42:832–836

    CAS  PubMed  Google Scholar 

  15. Pugnale N, Waridel F, Bouzourene H, Boubaker A, Pugnale M, Gaillard RC, Gomez F (2003) Pharyngeal pituitary non-functioning adenoma with normal intra-sellar gland: massive tumor shrinkage on octreotide therapy. Eur J Endocrinol 148:357–364

    Article  CAS  PubMed  Google Scholar 

  16. Rubinstein AB, Arbit E (1985) Intracranial meningiomas presenting with epistaxis—case report and literature review. J Otolaryngol 14:248–250

    CAS  PubMed  Google Scholar 

  17. Aghadiuno PU, Thomas SM, Ogan O, Martinson FD, Adeloye A (1983) Olfactory neuroblastoma. A case report in an African child. J Laryngol Otol 97:261–265

    CAS  PubMed  Google Scholar 

  18. Sharma HS, Reddy SC, Mohamad A, Kamal MZ, Halder D (1996) Metastatic osteosarcoma of the ethmoid: an unusual cause of recurrent epistaxis and proptosis. J Laryngol Otol 110:676–678

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Ryuhei Kitai.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kitai, R., Yoshida, K., Kubota, T. et al. Clival chordoma manifesting as nasal bleeding. A case report. Neuroradiology 47, 368–371 (2005).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: