Spontaneous Retropharyngeal Hematoma - A Case Report -

Abstract

Spontaneous retropharyngeal hematoma is rare and difficult to diagnosis early. A 23-year-old male spontaneously developed acute onset of neck pain, limitation of neck motion, and mild dysphagia. Magnetic resonance imaging demonstrated blood products in prevertebral space from C2 to C4, suggesting a diagnosis of retropharyngeal hematoma. We report a rare case of spontaneous retropharyngeal hematoma causing neck pain.

Spontaneous Retropharyngeal Haematoma in a One-Year-Old Child: A Case Report

“…Anticoagulation or hemorrhagic diathesis predisposes an individual to develop retropharyngeal hematoma. Spontaneous retropharyngeal hematoma is defined by the absence of any clear etiology, and there are only a few case reports in the English literature [3].…”

“…Clinically, spontaneous retropharyngeal hematoma can present as a triad of features including superior mediastinal obstruction, anterior tracheal displacement and bruising on the neck within 48 hours with subsequent spreading to the chest wall [3]. However, in cases with no history of trauma, early diagnosis in an emergency department may be challenging because of non-specific symptoms, such as neck swelling or refused to feed and respiratory distress, especially when a hematoma is huge in a retropharyngeal space.…”

“…Retropharyngeal tendinitis is due to calcific deposits within the tendons of the longus colli muscles as in calcific deposits in calcific tendinitis of the shoulder. Radiographic findings are characteristically amorphous calcification localized anterior to C1 with associated swelling of the prevertebral (or retropharyngeal) soft tissues from C1 through C4 [3]. Clinical features are sudden onset of severe pain in the neck and throat aggravated by swallowing and movement of the head; this may be associated with mild fever and elevation of ESR.…”

“…Clinical findings of retropharyngeal infection include acute to subacute onset of neck pain, dysphagia, or odynophagia; mildly elevated WBC count; and low-grade fever. ESR may be mildly elevated, and there may be a recent history of upper respiratory infection or minor trauma to the head or neck [3]. Careful history taking, checking for signs of fever, and close follow-up of laboratory tests are important in differential diagnosis of retropharyngeal infection.…”

“…In cases involving large hematomas, first we secure the airway by orotracheal intubation and close monitoring of the vitals followed by surgical drainage in OT. Muñoz et al [3] reported that in spontaneously developed hematoma, nearly complete absorption was observed after 1 week. However, in our case, symptoms gradually worsened and the patient went in severe respiratory distress; therefore, we went for immediate surgical drainage in OT under general anaesthesia to minimize the chances of aspiration.…”