Retropharyngeal hematoma: Two case reports

Abstract

Retrofarengeal hematom (RH), whiplash kafa travması ve antikoagülan kaynaklı koagülopatinin (AKK) nadir fakat potansiyel olarak ciddi bir komplikasyonudur. Literatürde, hematomun cerrahi drenajı kararı konusunda ikilem vardır ve fazla veri bulunmaktadır. Bu yazıda, acil servise farklı etyoloji ve semptomlarla başvuran iki ayrı olgu sunuldu. İlk olgu, kalp kapak hastalığı nedeniyle uzun süredir varfarin sodyum kullanan ve ilacın dozunu ayarlayamayan bir hastada gelişen spontan RH idi ve ikinci olgu, bir çocukta minör kafa travmasından sonra izole bir hematom idi. İlk hastaya acil trakeotomi gerekirken ikinci hastaya konservatif tedavi uygulandı. Retrofarengeal hematomda tedavi, etyolojiye ve semptomların şiddetine göre değişebilir. Hava yolu tıkanıklığı belirtileri ortaya çıktığında, tamamen tıkanma meydana gelmeden önce hava yolu derhal emniyete alınmalıdır. Antikoagüle bir hasta üst solunum yolu semptomları gösterdiğinde RH tanısı düşünülmelidir.

Spontaneous Retropharyngeal Haematoma Causing Upper Airway Obstruction in a Child: Case Report

“…Spontaneous retropharyngeal haematomas are a potentially fatal and unusual cause of upper airway obstruction. 3,7 Case reports have been described in Spain, 10 United Kingdom, 5 Turkey, 3 India, 6,8 Japan, 9 Korea, 4 and Morocco. 12 To the best of our knowledge, this is the first documented case report within the East African region and Uganda.…”

“…12 To the best of our knowledge, this is the first documented case report within the East African region and Uganda. The reported cases heavily comprise the adult population, [3][4][5][10][11][12] more so the elderly, 3,5,11 in comparison to the paediatric population. 6,8,9 Our 18-month-old patient falls within the paediatric category.…”

“…The recognized potential risk factors for retropharyngeal bleeding include anti-coagulation therapy, 3,11 foreign body ingestion and trauma from vigorous head movements, 3 straining with sneezing or coughing, 7 bleeding from rupture of arteries or paraoesophageal veins, 11 iatrogenic from angiographic procedures, 10 etc. Additionally, patients with Haemophilia A are seemingly at high risk of retropharyngeal bleeding.…”

“…The size of the retropharyngeal haematoma determines the clinical manifestations. Several authors describe dysphagia, 2,4-6 limited neck movement 3,4 or neck pain, 2,3 upper airway obstruction, [6][7][8][9] and dysphonia, 2,4,5,10 in no particular order. Rarely, Capps triad, which involves tracheal or esophageal compression, anterior displacement of the trachea and subcutaneous bruising over the neck and anterior chest, has been described in the adult population.…”

“…This is because the bony cervicothoracic spine located posteriorly cannot bulge. As the anterior bulge increases, clinical manifestations such as neck pain, 2,3 limited neck movement, 3,4 pain on swallowing, 2,[4][5][6] stridor with respiratory distress [4][5][6][7][8][9][10] or, in extreme circumstances of bleeding, Capp's triad 5,11,12 may ensue.…”