Traumatic Retropharyngeal Hematoma Necessitating Emergency Intubation

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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“…The incidence of airway obstruction resulting from retropharyngeal hematomas is low, but its occurrence can be life threatening [2,4,7]. …”

Section: Discussionmentioning

confidence: 99%

“…Patients whose symptoms are suggestive of retropharyngeal hematomas warrant close and often prolonged follow-up because, as with our patient, a delay can exist between the patient's initial injury or symptoms and the development of respiratory distress [1]. Although most patients become symptomatic immediately or within hours of the development of the hematoma, there have been reports of patients who experienced airway obstruction as long as 5 days after developing the initial symptoms of airway compression [4,6]. Clinicians should maintain a high degree of suspicion when evaluating patients presenting with symptoms of airway compression whose mechanism of injury is consistent with those associated with retropharyngeal hematomas because these initial symptoms may progress rapidly to lethal airway obstruction.…”

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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“…Most retropharyngeal haematomas are related to fractures of the cervical spine after high-energy accidents and occur in patients with anticoagulant treatment 1–4. Extensive retropharyngeal haematoma secondary to minor blunt head and neck trauma in patients without anticoagulants or antiplatelet agents is not a well-recognised condition, but clinicians should be alert to the potential for this delayed airway collapse 5 6.…”

Section: Introductionmentioning

confidence: 99%