Traumatic retropharyngeal hematoma: a rare and critical pathology needed for early diagnosis

Abstract

Retropharyngeal hematoma occurs rarely. It is located just in front of the cervical spine. Many circumstances can lead to its development. A trauma and/or anticoagulants are often key factors. The assessment must be made extremely carefully as such a hematoma can induce an airway compromise. Trauma being a key factor, it can also present with cervical spine fractures, increasing the risks. Two different cases of retropharyngeal hematomas are reported. The first case required surgical management with tracheotomy, per-oral drainage and naso-gastric tube feeding. A total recovery was obtained in 2 weeks. The second patient underwent medical treatment (methylprednisolone), and recovery was obtained in 6 days. Surgery for retropharyngeal hematoma is not always mandatory. It becomes necessary when a major dysphagia or dyspnea occurs. In other cases, medical treatment and close observation are usually sufficient.

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

“…Most documented causes of RH have occurred in the context of cervical fractures, violent coughing, ruptured aneurysm, pharyngeal foreign bodies, injury of cervical blood vessels, vomiting, muscular exercise, deep neck infection, haemorrhagic parathyroid adenoma, iatrogenic injury associated with cardiac catheterisation, cerebral angiography and jugular vein cannulation, spontaneous haemorrhagic with or without anticoagulation therapy, flexion and hyperextension of the neck (fall, motor vehicle accident or airbag deployment) with contusion,6 8 14–17 and laceration of the soft tissues and vessels 7. Anticoagulation and coagulopathic states are important risk factors 18 19…”

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

“…Die normale Ausdehnung des retropharyngealen Raumes, d. h. von der vorderen, unteren Seite des Wirbelkörpers C2 bis zur Hinterseite des Pharynx misst 1-7 mm, während der normale retrotracheale Raum, d. h. von der vorderen, unteren Seite des Wirbelkörpers C6 bis zur Hinterseite der Trachea 9-22 mm beträgt. Der dringende Verdacht einer Einblutung kann geäußert werden, wenn der retropharyngeale Raum weniger als die Hälfte der entsprechenden zervikalen Wirbelsäule ausmacht [16].…”

“…Dabei kann transoral eine Aspiration vorgenommen oder offen über einen lateralen, zervikalen Zugang eine Drainage durchgeführt werden. Die Gefahr einer bakteriellen Kontamination des retropharyngealen Raumes ist durch strenge Asepsis und antibiotische Therapie zu minimieren [15,16].…”

“…Kompression der Weichteile und der Halsgefäße kann über eine Reizung des N. vagus zu persistierenden Kreislaufproblemen führen, die weitere interventionelle Behandlungen notwendig macht [8,14,16].…”

Anesthetic implications of the new anticoagulant and antiplatelet drugs

“…Risks associated with compromised coagulation status may include increased perioperative blood loss [1][2][3][4], threat of epidural hematoma formation after neuraxial anesthesia [5,6], intrapulmonary hemorrhage after PA catheter placement [7], significant nasal bleeding after nasotracheal intubation, nasogastric tube placement [8][9][10], and others.…”