Traumatic Retropharyngeal Hematoma

SUMMARYRetropharyngeal haematoma (RH) is an extremely rare but potentially life-threatening condition that requires an early diagnosis and immediate management. Acute complications arise from compression and obstruction of the upper airway and oesophagus with the risk of consecutive aspiration. We present the case of a 48-yearold man with formation of a RH after accidental ingestion of a large fish bone with hypertension as comorbidity caused by a so far undiagnosed pheochromocytoma. The patient presented with acute onset of retropharyngeal pain, dysphonia and dysphagia secondary to fish bone foreign body ingestion. His medical history was significant for uncontrolled hypertension. CT showed a large RH extending from the oropharynx to the superior mediastinum. The patient underwent emergency tracheostomy, surgical debridement and removal of the fish bone. Antihypertensive medication was utilised to control his labile blood pressure. The postoperative CT scan revealed an adrenal pheochromocytoma that was subsequently resected. BACKGROUND

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“…These patients should be followed radiographically to ensure complete resolution of the haematoma 10 21…”

Section: Discussionmentioning

confidence: 99%

Acute airway obstruction due to retropharyngeal haematoma caused by a large fish bone in a patient with hypertension caused by a pheochromocytoma

et al. 2015

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“…It begins at the base of the skull and terminates in the superior mediastinum [1,2]. The mechanisms triggering hemorrhage into the retropharyngeal space are thought to include injury to the longus colli muscles on the anterior surface of the vertebral bodies, the anterior longitudinal ligament or the anterior muscular and spinal branches of the vertebral arteries [2-5]. These injuries are most commonly associated with closed cervical neck trauma [6] and anticoagulant therapy [1], but they have also been attributed to blunt head trauma, bleeding diathesis, cannulation of the internal jugular vein, arteriography, whiplash injury, foreign body ingestion, retropharyngeal infection, carotid artery aneurysm, carotid sinus massage, metastatic disease and can even occur spontaneously [6-8].…”

Section: Discussionmentioning

confidence: 99%

“…Although treatment course may vary depending on the etiology of the hematoma, the first step in management is establishing definitive airway control [5]. If no airway compromise is present and the patient has a small, stable hematoma, conservative management and observation are indicated.…”

Section: Discussionmentioning

confidence: 99%

“…If no airway compromise is present and the patient has a small, stable hematoma, conservative management and observation are indicated. These patients should be followed radiographically to ensure complete resolution of the hematoma [4,5]. Patients with airway compromise, however, should be managed aggressively utilizing a multidisciplinary approach including an experienced anesthesiologist and surgeon prepared to perform emergent tracheostomy if indicated.…”

Section: Discussionmentioning

confidence: 99%

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Severe upper airway obstruction due to delayed retropharyngeal hematoma formation following blunt cervical trauma

et al. 2007

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BackgroundWe report a case of severe upper airway obstruction due to a retropharyngeal hematoma that presented nearly one day after a precipitating traumatic injury. Retropharyngeal hematomas are rare, but may cause life-threatening airway compromise.Case presentationA 50 year-old man developed severe dyspnea with oropharyngeal airway compression due to retropharyngeal hematoma 20 hours after presenting to the emergency department. The patient also had a fractured first cervical vertebra and was diagnosed with a left brachial plexopathy. The patient underwent emergent awake fiberoptic endotracheal intubation to provide a definitive airway.ConclusionRetropharyngeal hematoma with life-threatening airway compromise can develop hours or days after a precipitating injury. Clinicians should be alert to the potential for this delayed airway collapse, and should also be prepared to rapidly secure the airway in this patient population likely to have concomitant cervical spinal or head injuries.

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“…Als auslösende Faktoren einer Einblutung in den retropharyngealen Raum werden Verletzungen des M. longus colli an der Vorderseite der Wirbelkörper, an dem Ligamentum longitudinale oder an den vorderen Ästen der A. vertebralis diskutiert [7,9,10]. Diese Verletzungen sind häufig assoziiert mit einem Halstrauma unter einer Therapie mit Antikoagulantien.…”

Section: Diskussionunclassified

Severe upper airway obstruction due to retropharyngeal haematoma formation following cervical trauma

Haarmann

Budihardja

Mücke

et al. 2007

Mund Kiefer GesichtsChir

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Mechanical airway obstruction secondary to retropharyngeal bleeding is rare. In most cases such a complication is described after head and neck trauma. Complicating factors include anticoagulant therapy, tumour, aneurysm, infection or major cervical spine injury. A precise initial diagnosis is necessary to avoid a life-threatening situation. Lateral X-ray and computed tomography is essential for safe management.Treatment depends upon size of the haematoma as well as the clinical course of the patient. Smaller haematomas may be observed. Lager haematomas and those that fail to reabsorb should undergo drainage.

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Traumatic Retropharyngeal Hematoma

Cited by 16 publications

References 6 publications

Acute airway obstruction due to retropharyngeal haematoma caused by a large fish bone in a patient with hypertension caused by a pheochromocytoma

Acute airway obstruction due to retropharyngeal haematoma caused by a large fish bone in a patient with hypertension caused by a pheochromocytoma

Severe upper airway obstruction due to delayed retropharyngeal hematoma formation following blunt cervical trauma

Severe upper airway obstruction due to retropharyngeal haematoma formation following cervical trauma

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