Fatal retropharyngeal haematoma secondary to blunt trauma

Sudden Asphyxia Caused by Retropharyngeal Hematoma after Blunt Thyrocervical Artery Injury

“…Most such patients sustain injuries in motor vehicle accidents or a fall (2-9). The initial symptoms of airway obstruction include dyspnea, stridor, hoarseness, dysphagia, painful swallowing, neck pain, and neck swelling (2)(3)(4)(5)(6)(7)(8)(9). Because evaluating the size of the retropharyngeal hematoma from the outside of the body is difficult, the quickest and easiest way to diagnose this condition is to obtain a lateral cervical spine plain radiograph (10).…”

“…Airway obstruction-inducing retropharyngeal hematoma is most commonly associated with cervical spine injuries with dislocation of the vertebral body and arch, transverse fracture of the vertebral body, subluxation, dislocation fracture, atlantooccipital fracture dislocation, displaced type 2 odontoid fracture, and hangman's fracture (2)(3)(4)(5)(6)(7)(8). In contrast, there are few reports of airway obstruction in non-displaced cervical spine injury caused by vigorous hemorrhage from blunt cervical artery injury (9,11,12).…”

“…Although such hematomas typically resolve after conservative management, urgent airway stabilization is essential for airway obstruction due to delayed swelling of the hematoma (2). Retropharyngeal hematoma responsible for airway obstruction is most often associated with cervical spine injury with dislocation of the vertebral body and arch, and blunt cervical artery injuries rarely lead to hematoma formation (2)(3)(4)(5)(6)(7)(8).…”

An elderly woman with increasing dyspnoea after a fall

“…Retropharyngeal haematomas not associated with cervical spine fractures have been observed after car accidents with high-energy hyperextension injuries 1 2. It is presumed that the haematoma in these cases results from extensive damage of muscles and ligaments which cover the anterior aspect of the vertebral bodies and from the rupture of large anterior branches of vertebral arteries 1 9. Retropharyngeal and prevertebral haematoma, after minor blunt trauma of the head or neck, is an uncommon condition that has infrequently been reported in older people with pre-existing risk factors including osteophytes, degenerative soft tissue changes and particularly anticoagulation therapy 8 9.…”

“…It is presumed that the haematoma in these cases results from extensive damage of muscles and ligaments which cover the anterior aspect of the vertebral bodies and from the rupture of large anterior branches of vertebral arteries 1 9. Retropharyngeal and prevertebral haematoma, after minor blunt trauma of the head or neck, is an uncommon condition that has infrequently been reported in older people with pre-existing risk factors including osteophytes, degenerative soft tissue changes and particularly anticoagulation therapy 8 9. Possible symptoms of retropharyngeal haematomas include dysphagia, dyspnoea, a sore throat, neck pain, dysphonia and swelling of the neck in case of widespread haematomas.…”