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BMJ Case Rep 2021 May 13;14(5). Epub 2021 May 13.

Ear, nose and throat, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.

A 79-year-old man presented to the emergency department following a 1-week history of dyspnoea, dysphonia, dysphagia and a nonproductive cough. Previous medical history included atrial fibrillation, for which he was taking rivaroxaban, hypertension and obstructive sleep apnoea. On assessment, there was a mild stridor, swelling of the anterior aspect of the neck and submandibular bruising. Read More

BMC Surg 2021 Apr 27;21(1):220. Epub 2021 Apr 27.

Department of Radiology, Chungbuk National University Hospital, 776, 1sunhwan-ro, Seowon-g, Cheongju-si, Chungcheongbuk-do, Republic of Korea.

Background: Fine needle aspiration (FNA) of the thyroid gland is an effective and safe method for evaluating thyroid nodules; catastrophic complications following FNA of thyroid are rare. Massive hematomas with active bleeding leading to airway compromise are extremely rare complications of FNA, with only a few reported cases in literature.

Case Presentation: An 80 year-old man presented to the emergency room with severe respiratory distress, four hours after undergoing thyroid FNA for the evaluation of a thyroid nodule. Read More

J Belg Soc Radiol 2021 Mar 16;105(1):15. Epub 2021 Mar 16.

Clinique Saint-Pierre Ottignies, BE.

Retropharyngeal hematoma appearing under rivaroxaban is uncommon but should be suspected in cases of dysphagia, dysphonia or breathing difficulties. Read More

Trauma Case Rep 2021 Apr 20;32:100442. Epub 2021 Feb 20.

Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, United States of America.

We described the case of 75 years old male patient with an airway obstruction due to retropharyngeal hematoma that developed after a minor blunt trauma to the face. The patient was not taking any anticoagulants or antiplatelet agents and did not have any coagulopathy. This case report indicates that emergency physicians must be aware of the risk of delayed airway obstruction in elderly patients regardless of whether the patient is using anticoagulants or antiplatelet agents. Read More

Acute Med Surg 2021 Jan-Dec;8(1):e632. Epub 2021 Feb 6.

Department of Anesthesiology and Critical Care Saitama Medical Center Jichi Saitama Japan.

Am J Emerg Med 2021 Feb 2. Epub 2021 Feb 2.

Department of Emergency Medicine, Japanese Red Cross Ishinomaki Hospital, Miyagi, Japan.

Retropharyngeal hematoma is a potentially life-threatening condition because it can easily lead to airway obstruction. Most of the previously reported cases of retropharyngeal hematoma are caused by predisposing factors such as head and neck trauma, the use of anticoagulants, or the presence of underlying bleeding diathesis. Herein, we report a case of retropharyngeal hematoma in a patient with chronic alcoholism, where we could not confirm any predisposing factors at the time of examination. Read More

Int J Emerg Med 2021 Jan 7;14(1). Epub 2021 Jan 7.

Emergency and Critical Care Medical Center, Teine Keijinkai Hospital, 1-jo 12-chome 1-40, Maeda, Teine-ku, Sapporo, 006-8555, Japan.

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. Read More

Clin Pract Cases Emerg Med 2020 Nov;4(4):634-635

University of Ottawa, Department of Emergency Medicine, Ottawa, Ontario, Canada.

Case Presentation: A 63-year-old female presented to the emergency department complaining of cough, neck swelling, dysphagia, and dysphonia for two days, with a past medical history of atrial fibrillation managed with warfarin. Investigations revealed a supratherapeutic international normalised ratio (greater than 10). Imaging and endoscopic examination showed an extensive retropharyngeal hematoma with significant mass effect on the airway. Read More

Int J Surg Case Rep 2020 4;77:321-324. Epub 2020 Nov 4.

Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.

Introduction: Blunt neck trauma patients can suffer from an airway emergency and are necessary to careful observation.

Presentation Of Case: A 79-year-old man under anticoagulation therapy presented to our hospital three hours after a fall. Shortly after arrival, he developed dyspnea. Read More

Surg Neurol Int 2020 21;11:356. Epub 2020 Oct 21.

Clinical Professor of Neurological Surgery, School of Medicine, State University of NY at Stony Brook, New York, United States.

Background: We reviewed the frequency, recognition, and management of postoperative hematomas (HT) (i.e. retropharyngeal [RFH], wound [WH], and/or spinal epidural hematomas [SEH]) following anterior cervical discectomy/fusion (ACDF), anterior corpectomy fusion (ACF), and/or anterior cervical spine surgery (ACSS). Read More

Korean J Neurotrauma 2020 Oct 26;16(2):343-347. Epub 2020 Oct 26.

Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Busan, Korea.

Traumatic retropharyngeal hematoma is a potentially life-threatening complication of cervical spine injury due to possible airway obstruction. Treatment by securing airway and subsequent conservative care is often adequate. However, a rapidly expanding large hematoma requires surgical evacuation. Read More

Med Klin Intensivmed Notfmed 2020 Oct 15. Epub 2020 Oct 15.

Interdisziplinäre Intensivstation, Spital Bülach, 8180, Bülach, Schweiz.

Global Spine J 2020 May 13:2192568220922192. Epub 2020 May 13.

Swedish Medical Center, Seattle, Washington, DC, USA.

Study Design: Cadaver study.

Objective: The retropharyngeal space's (RPS's) clinical relevance is apparent in anterior cervical spine surgery with respect to postoperative hematoma, which can cause life-threatening airway obstruction. This cadaver study aims to establish guidance toward a better understanding of the tolerance of the RPS to accommodate fluid accumulation. Read More

No Shinkei Geka 2020 Aug;48(8):707-710

Department of Neurosurgery, Makita General Hospital.

Retropharyngeal hematomas are uncommon, but they may rarely cause occlusion of the upper airway and threaten life. Retropharyngeal hematomas often occur due to head or neck injury;they rarely occur due to iatrogenic causes such as insertion of a gastric tube or anticoagulant therapy. It has been found that patients receiving anticoagulant therapy are more likely to experience potentially severe retropharyngeal hematomas. Read More

Medicine (Baltimore) 2020 Jul;99(31):e21528

Department of Thoracic & Cardiovascular Surgery, Korea University Anam Hospital, Seoul, Korea.

Rationale: Massive retropharyngeal hematoma secondary to a minor blunt trauma is rare and easy to be missed in emergency settings due to the absence of visible tissue injury, especially in young patients. However, missing this pathology is dangerous and can result in airway obstruction and even death. Therefore, an effective diagnostic strategy must be developed and thoroughly performed to minimize missed retropharyngeal hematoma. Read More

Eur Arch Otorhinolaryngol 2020 Sep 11;277(9):2551-2558. Epub 2020 Apr 11.

Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.

Purpose: Spontaneous neck hematoma is a rare yet potentially fatal complication of primary hyperparathyroidism (PHPT). Here we aim to describe novel presentations of neck hematomas secondary to PHPT, discussing tools and signs that facilitate diagnosis.

Methods: Case series data were extracted by retrospective chart reviews of our institution's electronic medical records, including all neck hematoma cases from parathyroid origin between 2005 and 2020. Read More

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2019 12;54(12):930-933

Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China.

J Forensic Sci 2020 May 28;65(3):987-990. Epub 2019 Oct 28.

Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.

We report a fatal case of airway obstruction caused by spontaneous retropharyngeal hematoma (RH) in the setting of treatment with dipyridamole. A 90-year-old woman presented with cervical swelling, neck and chest ecchymoses, and complaints of dyspnea. She suffered cardiopulmonary arrest in the ambulance, and her death was confirmed after transportation to the hospital. Read More

Medicine (Baltimore) 2019 Sep;98(38):e17247

Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou, P.R. China.

Rationale: Retropharyngeal hematoma (RH) is an infrequent but potentially life-threatening complication of anterior cervical spine surgeries (ACSS). Challenging situations might be confronted and catastrophic events or even deaths still occurred occasionally during the treatment. Currently, no widely accepted protocol has been developed. Read More

J Med Case Rep 2019 Aug 24;13(1):269. Epub 2019 Aug 24.

Department of Otolaryngology, Head and Neck Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.

Background: Obstructive sleep apnea is related to increased systemic inflammation and arterial hypertension. We present a case of retropharyngeal hematoma without trauma und hypothesize that this could be caused by untreated obstructive sleep apnea.

Case Presentation: A 47-year-old white woman with unilateral pharyngeal discomfort presented to our ear, nose, and throat clinic. Read More

Am J Case Rep 2019 Jul 15;20:1022-1026. Epub 2019 Jul 15.

Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu, Mie, Japan.

BACKGROUND Massive tongue hemorrhage in patients with hemophilia is a medical emergency because it can lead to airway obstruction. However, managing bleeding in patients with inhibitors is more difficult than in patients without inhibitors. We report a case of life-threatening massive tongue and retropharyngeal hematoma in a patient with hemophilia A who had inhibitors. Read More

Arch Pediatr 2019 Jul 4;26(5):298-300. Epub 2019 Jul 4.

Departement of Pediatric Emergency, Hôpital Necker-Enfants Malades, Assistance publique-hôpitaux de Paris, 149, rue de Sèvres, 75743 Paris cedex 15, France; Faculté de Médecine, Paris Descartes, 15, rue de l'École de Médecine, 75006 Paris, France.

Neck abscesses after a cervical trauma rarely occur, especially in children. Cervical abscesses are more generally complications of otolaryngological infections. Progression to severe complication or death may be rapid. Read More

Ther Clin Risk Manag 2019 17;15:669-675. Epub 2019 May 17.

Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School, Jeonju, South Korea,

Background: Retropharyngeal hematoma following cervical spine trauma may lead to life-threatening upper airway obstruction and difficult airway management. This retrospective study was performed to investigate whether the extension of retropharyngeal space (RPS) was associated with difficult intubation by direct laryngoscopy in traumatic cervical spine injury.

Patients And Methods: Sixty-two patients who had undergone direct endotracheal intubation under general anesthesia for cervical spine surgery were retrospectively identified. Read More

J Am Acad Orthop Surg 2020 Jan;28(1):21-28

From the Indiana Spine Group, Carmel, IN (Dr. Jenkins, Dr. Snowden, Dr. Smucker, and Dr. Sasso), the Department of Orthopaedic Surgery, Northwestern University, Chicago, IL (Dr. Jenkins, Dr. Hsu), the Department of Orthopaedic Surgery, Spine Hospital, Columbia University Medical Center, New York, NY (Dr. Riew), and the Columbia Orthopaedic Group, Columbia, MO (Dr. Jenkins).

Introduction: Despite the proven success of anterior cervical surgery (ACS) postoperative issues can arise, with retropharyngeal hematoma (RH) being one of the most feared. A recent USA Today article highlighted the failed management and subsequent death of patients developing RH after ACS. The article calls into question the safety of performing ACS in an outpatient setting. Read More

J Spine Surg 2019 Mar;5(1):142-154

Department of Orthopaedic Surgery, Virginia Commonwealth University Health, Richmond, VA, USA.

Anterior cervical spine surgery (ACSS) is a common procedure, but not without its own risks and complications. Complications that can cause airway compromise occur infrequently, but can rapidly lead to respiratory arrest, leading to severe morbidity or death. Knowing emergent post-operative airway management including surgical airway placement is critical. Read More

Ned Tijdschr Geneeskd 2019 02 1;163. Epub 2019 Feb 1.

LUMC, afd. Keel- Neus- en Oorheelkunde, Leiden.

A 91-year-old woman visited the emergency department with dyspnea and globus sensation after a minor head injury. A CT-scan of the spine showed a retropharyngeal swelling. MRI and fiberscopy revealed that the swelling was concordant with a retropharyngeal hematoma. Read More

Case Rep Emerg Med 2018 13;2018:6147473. Epub 2018 Aug 13.

Department of Emergency Medicine, Michigan State University College of Human Medicine, Sparrow Health System Lansing, Michigan, USA.

The development of a retropharyngeal hematoma may lead to acute airway compromise requiring emergent airway stabilization. We describe the development of a retropharyngeal hematoma in an elderly woman who sustained a fall from standing approximately 10 hours prior to symptom onset who was taking the antiplatelet agents clopidogrel and aspirin. This delayed onset of rapid airway compromise secondary to a retropharyngeal hematoma following a fall in a patient taking clopidogrel is an unusual and potentially life threatening event. Read More

Am J Case Rep 2018 Aug 17;19:969-972. Epub 2018 Aug 17.

Frank H. Netter MD School of Medicine, Quinnipiac University, Hamden, CT, USA.

BACKGROUND Retropharyngeal hematoma is a relatively rare diagnosis that requires a high clinical suspicion and stabilization of the airway to prevent rapid deterioration. We report a case of a spontaneous retropharyngeal hematoma in an elderly patient with myelodysplastic syndrome and associated thrombocytopenia. CASE REPORT A 90-year-old man with myelodysplastic syndrome was brought to the Emergency Department with complaints of difficulty swallowing and muffled voice for 24 hours. Read More

Neurochirurgie 2018 Jun 4;64(3):166-170. Epub 2018 May 4.

Department of Orthopedics, The First Affiliated Hospital of China Medical University,Shenyang,Republic of China.

Objective: Postoperative hematoma is a rare and dangerous complication of cervical spine surgery. The aim of this study was to investigate the incidence and related factors of postoperative hematoma, and to report on 15 cases at our institution over a 6-year period.

Methods: Fifteen cases of postoperative hematoma were retrospectively identified. Read More

World J Surg 2018 05;42(5):1415-1423

Department of Otolaryngology - Head and Neck Surgery, University of Nevada Las Vegas School of Medicine, 1701 W Charleston Blvd, Suite 490, Las Vegas, NV, 89102, USA.

Background: Resection of massive goiters with suprahyoid, retropharyngeal, and substernal extension may not be amenable to standard approaches. This study evaluates a surgical approach allowing resection of massive goiters with minimal substernal and deep neck dissection.

Methods: Cases of thyroidectomy for goiters with substernal, retropharyngeal, or suprahyoid extension at a single institution from 2006 to 2017 were reviewed. Read More