Spontaneous Uvula, Soft Palate and Pharynx Hematoma

Abstract

Eighty year-old male patient presented to our emergency department with dysphagia and dyspnea. The patient was diagnosed with chronic renal failure 12 years ago and had been receiving hemodialysis. Last hemodialysis with heparin was received 8 hours ago and the patient started to get the feeling of something stuck in the throat and had dyspnea. In examination, a hematoma on uvula and soft palate that significantly obstructed oropharynx, and 2x3 cm submucosal hematoma on posterior wall of oropharynx were observed (Figure 1). In fiberoptic laryngoscopy, larynx was normal and rima glottis was not obstructed. In anamnesis, there was no dental intervention or trauma history. Oxygen saturation was determined as 98%, body temperature was normal. Due to high saturation and open air passage, emergency tracheotomy or laryngeal intubation was not considered. In laboratory analysis, prothtrombin time (PT) was 18.3 seconds, active partial thromboplastin time (APTT) was immeasurably long (>200). Hemoglobin was 10.6, leukocyte count was 7190, thrombocyte count was 225.000, BUN was 31 mg/dL, creatinine was 5.2 mg/dL , Na was 140 mEq/L, K was 4.7 mEq/L. Due to normal oxygen saturation, emergency surgery was not considered. The patient was transferrred to the ward due to high APTT, and fresh frozen plasma replacement was performed. Parenteral steroid and antibiotic therapy were initiated. Dialysis without anticoagulant was performed during follow-up period. Hematomas on uvula, soft palate and oropharynx were resolved. Physical examination and laboratory findings of the patient recovered expeditiously and APTT value was decreased to therapeutic levels, so the patient was discharged and advised to come back for policlinic controls. Submit Manuscript AbstractIn patients who receive hemodialysis, incidence of bleeding disorders is increased and the complications include various systemic bleeding. In these patients, an important factor that increases the severity of hemorrhage is chronic systemic heparinization. Hemorrhage that involves respiratory tract causes a severe clinical manifestation due to the risk of airway obstruction. Hematoma that involves uvula, soft palate and pharynx is a rare complication. Uvula hematomas which develop after trauma or thrombolytic therapy have been reported in the literature [1][2][3][4]. Here, we present a case receiving hemodialysis for 12 years and has spontaneous submucosal hematomas that involves uvula, soft palate and posterior wall of oropharynx as a rare but serious complication due to heparin that involves uvula, soft palate and posterior wall of oropharynx.