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Published in: International Journal of Emergency Medicine 1/2021

Open Access 01-12-2021 | Computed Tomography | Case report

Successful management of retropharyngeal hematoma by trans-arterial embolism without intubation

Authors: Gaku Sugiura, Hiroyuki Takahashi, Yoshihisa Kodama, Satoshi Nara

Published in: International Journal of Emergency Medicine | Issue 1/2021

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Abstract

Background

Retropharyngeal hematoma can cause suffocation if there is delay in securing the airway by intubation. However, there are also concerns about complications that can arise with intubation; it is still unknown which cases do not require intubation.

Case presentation

An 88-year-old woman slipped and was found prone and was transported to the emergency room. She was alert without any stridor. Physical examination revealed a subcutaneous hematoma in the anterior cervical region. Computed tomography revealed a retropharyngeal hematoma. Angiography and computed tomography angiography showed extravasation from the right costocervical trunk. A radiologist performed trans-arterial embolization, and she had an uneventful course without intubation or developing any complication. She became ambulatory on postoperative day 5.

Conclusion

Angiography and computed tomography angiography help in early recognition of extravasation in retropharyngeal hematoma, and trans-arterial embolization can help to avoid intubation and its complications.
Literature
1.
go back to reference Sheah K, Hui F, Wansaicheong G, Khoo M. Retropharyngeal haemorrhage from a vertebral artery branch treated with distal flow arrest and particle embolisation. Singapore Med J. 2006;47:719–23.PubMed Sheah K, Hui F, Wansaicheong G, Khoo M. Retropharyngeal haemorrhage from a vertebral artery branch treated with distal flow arrest and particle embolisation. Singapore Med J. 2006;47:719–23.PubMed
2.
go back to reference Myssiorek D, Shalmi C. Traumatic retropharyngeal hematoma. Arch Otolaryngol Head Neck Surg. 1989;115:1130–2.CrossRef Myssiorek D, Shalmi C. Traumatic retropharyngeal hematoma. Arch Otolaryngol Head Neck Surg. 1989;115:1130–2.CrossRef
3.
go back to reference Mackenzie JW, Jellicoe JA. Acute upper airway obstruction. Spontaneous retropharyngeal haematoma in a patient with polycythaemia rubra vera. Anaesthesia. 1986;41:57–60.CrossRef Mackenzie JW, Jellicoe JA. Acute upper airway obstruction. Spontaneous retropharyngeal haematoma in a patient with polycythaemia rubra vera. Anaesthesia. 1986;41:57–60.CrossRef
4.
go back to reference Iizuka S, Morita S, Otsuka H, et al. Sudden asphyxia caused by retropharyngeal hematoma after blunt thyrocervical artery injury. J Emerg Med. 2012;43:451–6.CrossRef Iizuka S, Morita S, Otsuka H, et al. Sudden asphyxia caused by retropharyngeal hematoma after blunt thyrocervical artery injury. J Emerg Med. 2012;43:451–6.CrossRef
5.
go back to reference Van Velde R, Sars PR, Olsman JG, Van De Hoeven H. Traumatic retropharyngeal haematoma treated by embolization of the thyrocervical trunk. Eur J Emerg Med. 2002;9:159–61.CrossRef Van Velde R, Sars PR, Olsman JG, Van De Hoeven H. Traumatic retropharyngeal haematoma treated by embolization of the thyrocervical trunk. Eur J Emerg Med. 2002;9:159–61.CrossRef
6.
go back to reference Calogero CG, Miller AC, Greenberg MR. Life-threatening retropharyngeal hemorrhage secondary to rupture of the inferior thyroid artery. Case Rep Emerg Med. 2015;2015:789076.PubMedPubMedCentral Calogero CG, Miller AC, Greenberg MR. Life-threatening retropharyngeal hemorrhage secondary to rupture of the inferior thyroid artery. Case Rep Emerg Med. 2015;2015:789076.PubMedPubMedCentral
7.
go back to reference Jakanani G, Kenningham R, Bolia A. Active retropharyngeal hemorrhage from an acute thyrocervical artery injury: a rare complication of hyperextension cervical spine injury. J Emerg Med. 2012;43:e39–41.CrossRef Jakanani G, Kenningham R, Bolia A. Active retropharyngeal hemorrhage from an acute thyrocervical artery injury: a rare complication of hyperextension cervical spine injury. J Emerg Med. 2012;43:e39–41.CrossRef
8.
go back to reference Kudo S, Fukushima K, Hashimoto M, Furutake M, Tanaka K, Okada K. Airway and circulatory collapse due to retropharyngeal hematoma after blunt vertebral artery injury. Am J Emerg Med. 2017;35:806.e5–7.CrossRef Kudo S, Fukushima K, Hashimoto M, Furutake M, Tanaka K, Okada K. Airway and circulatory collapse due to retropharyngeal hematoma after blunt vertebral artery injury. Am J Emerg Med. 2017;35:806.e5–7.CrossRef
9.
go back to reference Higa K, Hirata K, Hirota K, Nitahara K, Shono S. Retropharyngeal hematoma after stellate ganglion block: analysis of 27 patients reported in the literature. Anesthesiology. 2006;105:1238–45 discussion 5A–6A.CrossRef Higa K, Hirata K, Hirota K, Nitahara K, Shono S. Retropharyngeal hematoma after stellate ganglion block: analysis of 27 patients reported in the literature. Anesthesiology. 2006;105:1238–45 discussion 5A–6A.CrossRef
10.
go back to reference Song KJ, Choi BW, Lee DH, Lim DJ, Oh SY, Kim SS. Acute airway obstruction due to postoperative retropharyngeal hematoma after anterior cervical fusion: a retrospective analysis. J Orthop Surg Res. 2017;12:19.CrossRef Song KJ, Choi BW, Lee DH, Lim DJ, Oh SY, Kim SS. Acute airway obstruction due to postoperative retropharyngeal hematoma after anterior cervical fusion: a retrospective analysis. J Orthop Surg Res. 2017;12:19.CrossRef
11.
go back to reference Karmacharya P, Pathak R, Ghimire S, et al. Upper airway hematoma secondary to warfarin therapy: a systematic review of reported cases. N Am J Med Sci. 2015;7:494–502.CrossRef Karmacharya P, Pathak R, Ghimire S, et al. Upper airway hematoma secondary to warfarin therapy: a systematic review of reported cases. N Am J Med Sci. 2015;7:494–502.CrossRef
12.
go back to reference Betten DP, Jaquint JL. Traumatic retropharyngeal hematoma in a patient taking clopidogrel. Case Rep Emerg Med. 2018;2018:6147473.PubMedPubMedCentral Betten DP, Jaquint JL. Traumatic retropharyngeal hematoma in a patient taking clopidogrel. Case Rep Emerg Med. 2018;2018:6147473.PubMedPubMedCentral
Metadata
Title
Successful management of retropharyngeal hematoma by trans-arterial embolism without intubation
Authors
Gaku Sugiura
Hiroyuki Takahashi
Yoshihisa Kodama
Satoshi Nara
Publication date
01-12-2021
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Emergency Medicine / Issue 1/2021
Print ISSN: 1865-1372
Electronic ISSN: 1865-1380
DOI
https://doi.org/10.1186/s12245-020-00322-9

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