Retropharyngeal hematoma in a patient with chronic alcoholism

Abstract

Retropharyngeal hematoma is a potentially life-threatening condition because it can easily lead to airway obstruction. Most of the previously reported cases of retropharyngeal hematoma are caused by predisposing factors such as head and neck trauma, the use of anticoagulants, or the presence of underlying bleeding diathesis. Herein, we report a case of retropharyngeal hematoma in a patient with chronic alcoholism, where we could not confirm any predisposing factors at the time of examination. A 61-year-old man with chronic alcoholism presented to our emergency department with convulsive seizures. He was diagnosed with alcohol withdrawal and transferred to a secondary hospital after the seizure resolved. However, a few hours later, he returned to our department with a persistent cough and complained of pain and swelling in the neck. One hour later, he suddenly developed dyspnea; therefore, emergency intubation was performed. Although initially computed tomography (CT) showed normal findings, contrast-enhanced CT revealed a retropharyngeal hematoma. He was managed conservatively and transferred to a specialty hospital for intensive care. Chronic alcoholism may be a predisposing factor for retropharyngeal hematoma due to the high incidence of head trauma, neck hyperextension by convulsion, and hemostatic disorders. However, taking an accurate patient history is sometimes difficult because of the effects of intoxication or alcohol withdrawal. If a patient with chronic alcoholism presents with symptoms of airway compression, then a retropharyngeal hematoma should be suspected, and emergency intubation should be considered.

Thoracic spinal epidural hematoma misdiagnosed as conversion paralysis: A case report

“… 16 , 17 Alcoholism and alcoholic liver disorders have been noted to cause hemostatic disturbances, resulting in bleeding from even minor events. 18 , 19 This patient was taking anti‐alcoholic medication and did not consume any alcohol for the past year, and blood tests showed no abnormalities in coagulation capacity or liver function; therefore, the effects of alcohol were unknown, although they may have been latent.…”

“…16,17 Alcoholism and alcoholic liver disorders have been noted to cause hemostatic disturbances, resulting in bleeding from even minor events. 18,19 This patient was taking anti-alcoholic medication and did not consume any alcohol for the past year, and blood tests showed no abnormalities in coagulation capacity or liver function; therefore, the effects of alcohol were unknown, although they may have been latent. Poor prognostic factors for SCEH include the onset of pain at the mid and lower thoracic back, use of anticoagulants, loss of sphincter tone, severe neurologic impairment on admission, short progression interval, and spinal cord edema on MRI.…”

Cardiac arrest with retropharyngeal hematoma caused by minor facial injuries from a ground level fall

“…CT is the gold standard method to identify the presence of retropharyngeal hematoma. Most papers discussing traumatic retropharyngeal hematoma include CT images [ 4 , 9 ]. However, extension views of cervical spine images with angular instability are fairly unique, as we were unable to find similar images in any previous reports of patients with traumatic retropharyngeal hematoma.…”

“…Apparent potential risk factors for massive retropharyngeal hematoma include being elderly [ 12 ], use of anti-coagulant/platelet drugs [ 14 ], and chronic alcoholism [ 9 ]. Patients who have a fall episode and present with asphyxia should be diagnosed quickly for immediate consideration of early intervention, including endotracheal intubation, tracheostomy, cricothyroidotomy, neck exploration, and drainage of hematoma [ 15 ].…”