Retropharyngeal haematoma with subtotal upper airway obstruction after puncture attempt: a case report

Abstract

Mechanical complications during central catheterisation occur in approximately 15% of cases. This report describes a potentially fatal yet avoidable complication and highlights the typical radiological features of a retropharyngeal haematoma. A patient with acute myeloid leukaemia was admitted to the intensive care unit with respiratory distress immediately after an attempt to insert a subclavian catheter without ultrasound guidance. A computed tomography scan revealed nearly complete obstruction of the upper airway by a retropharyngeal haematoma, with a blush of contrast agent. There was also a mass effect on the trachea and mediastinal structures. The haematoma was caused by accidental puncture of the thyrocervical artery. The patient’s condition improved following orotracheal intubation, transfusion of platelets and fresh frozen plasma, arterial radio-embolisation, and clinical monitoring of haematoma resorption, which restored airway patency. A retropharyngeal haematoma is a potentially lethal complication, and its treatment carries significant risks. Therefore, central catheter insertion should likely not be attempted without ultrasound guidance to avoid serious complications for patients.