Traumatic retropharyngeal hematoma without spinal cord injury or spinal fracture: a retrospective multicenter analysis

Abstract

Background Retropharyngeal hematoma can be a life-threatening injury due to progressive upper airway obstruction. It is common following spinal cord injury or spinal fracture, and the clinical course and outcome of such patients are determined by their primary injuries. However, the natural clinical course of retropharyngeal hematoma itself remains unclear. In this study, we aimed to examine the clinical characteristics of traumatic retropharyngeal hematoma without spinal cord injury or spinal fracture (TREWISS). Methods We performed a multicenter retrospective analysis of patients who were diagnosed in the emergency department with soft tissue swelling of the retropharyngeal space by neck CT, between April 2010 and April 2020. The inclusion criterion was thickness of the retropharyngeal space > 7 mm at C1–C4 or > 22 mm at C5–C7 on a CT image. The exclusion criteria were (1) age < 18 years, (2) cardiopulmonary arrest, (3) other causes of soft tissue swelling besides hematoma, (4) patients with cervical spinal cord injury or spine fractures. Baseline characteristics were compared between intubated and non-intubated patients. Results Twenty-two patients were included in the analysis. Among them, 16 patients needed intubation. Median patient age was 69 years, and 27% of the patients were on antiplatelet or anticoagulant medications. The width of the hematoma on sagittal CT images was significantly wider in the intubated group [median (interquartile range), 2.5 cm (2.0–3.4) vs. 1.2 cm (0.9–1.7), p = 0.002). More than half the intubated patients needed tracheotomy. Tracheotomy was performed around day 3, and endotracheal tube was placed about 3 weeks. Only 60% of patients were successfully discharged to their homes, and one patient (6.3%) died during hospitalization. Conclusion Early intubation and subsequent intensive care are important for patients with TREWISS. The patients typically require several weeks of hospitalization, although their outcomes are usually poor. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-022-02203-7.

Traumatic retropharyngeal hematoma

“… 11 , 32 , 73 This was similar to the median diameter of the hematoma in the intubated cases in Shiba study. 88 These results confirm the predictive value of hematoma size in predicting the need for early intubation. Therefore, a large hematoma on sagittal CT images should be considered a red flag for early intubation.…”

“…Those receiving anticoagulants or those with coagulation disorders are at an increased risk of bleeding. 88 An additional study carried out by Shiba et al 88 indicated similar results with a median age of 69 and a male dominance distribution. It was also found in the same study by Shiba et al, 88 that high bleeding was associated with international normalized ratio of 4.5 and above.…”

“… 88 An additional study carried out by Shiba et al 88 indicated similar results with a median age of 69 and a male dominance distribution. It was also found in the same study by Shiba et al, 88 that high bleeding was associated with international normalized ratio of 4.5 and above. Sagittal CT images demonstrated significantly wider hematomas in the intubated group.…”

“…The presence of a wider hematoma on sagittal CT images indicates that earlier intubation is necessary. 88 According to other previous studies, the hematoma diameter in intubated patients ranged from 1.5-3.6 cm. 11 , 32 , 73 This was similar to the median diameter of the hematoma in the intubated cases in Shiba study.…”

“…Most studies we included reported CT scan findings consistent with our findings, including: cases of RHs (n=26, 38%), prevertebral soft tissue swelling (n=10, 15%), prevertebral hematomas (n=10, 15%), cervical fractures (n=9, 13%), hypoattenuating retropharyngeal collection (n=1, 2%), occipital condylar fractures (n=2, 3%), retropharyngeal soft tissue swelling (n=4, 6%), pharyngeal mass (n=5, 7%), and cervical spondylosis (n=1, 0.2%, Table 2 ). Shiba et al 88 reported a median width of 2.2 cm for the hematoma on sagittal CT images. The presence of a wider hematoma on sagittal CT images indicates that earlier intubation is necessary.…”