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Ned Tijdschr Geneeskd 2019 Feb 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

Rev Esp Anestesiol Reanim 2018 Apr 11;65(4):229-233. Epub 2017 Dec 11.

Departamento de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Son Llàtzer (HSLL), Palma de Mallorca, España.

Retropharyngeal haematoma is a life-threatening clinical situation that can lead to a potential obstruction of the upper airway and requires rapid diagnosis. Clinicaly, it can be presented in different ways, depending on its size and growing speed. The first measure is to protect and manage the airway: in most cases this is a difficult airway situation. Read More

Ear Nose Throat J 2017 Dec;96(12):E45-E46

Department of Otolaryngology and Head and Neck Surgery, Monash Health, Victoria, Australia.

Forensic Sci Med Pathol 2017 Dec 28;13(4):436-440. Epub 2017 Oct 28.

Ontario Forensic Pathology Service & Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.

We report the sudden death of a woman with neurofibromatosis type 1 (NF1). The decedent developed acute respiratory distress and died rapidly despite an emergent cricothyroidotomy. An autopsy with postmortem CT scan was performed to determine the cause of the fatal respiratory collapse and to determine if death was related to neurofibromatosis. Read More

Reg Anesth Pain Med 2017 Nov/Dec;42(6):778-781

From the *Department of Anesthesiology, Fukuoka University School of Medicine, Fukuoka, Japan; and †Care Center Himawarien, Fukuoka, Japan.

Background And Objective: Bleeding into the retropharyngeal space is a potential complication in stellate ganglion block (SGB). Retropharyngeal hematoma formation is considered to be due to damage of small arteries in the region, although only scanty details of the region are available. The aim of this study was to map the risk blood vessels in the retropharyngeal space to avoid accidental damage during SGB. Read More

Cardiol J 2017 15;24(2):131-138. Epub 2017 Feb 15.

Medical Clinic II (Cardiology/Intensive Care Medicine), Ketschendorfer Straße 33, 96450 Coburg, Germany, Tel. +49 9561 22 33215, Fax +49 9561 226419.

Background: The Amplatzer Amulet (St. Jude Medical, Minneapolis, MN, USA) is a second gen-eration Amplatzer device for left atrial appendage (LAA) occlusion (LAAO) for stroke prophylaxis in patients with atrial fibrillation. This research sought to assess the clinical performance of the Amplatzer Amulet device and in follow up for 12 months. Read More

J Orthop Surg Res 2017 Jan 26;12(1):19. Epub 2017 Jan 26.

Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Haeundae-ro 875, Haeundae-gu, Busan, 48108, Korea.

Background: Acute airway obstruction (AAO) after anterior cervical fusion (ACF) can be caused by postoperative retropharyngeal hematoma, which requires urgent recognition and treatment. However, the causes, evaluation, and appropriate treatment of this complication are not clearly defined. The purpose of this retrospective review of a prospective database was to investigate etiologic factors related to the development of AAO due to postoperative hematoma after ACF and formulate appropriate prevention and treatment guidelines. Read More

Am J Emerg Med 2017 May 9;35(5):806.e5-806.e7. Epub 2016 Dec 9.

Department of Emergency and Critical Care Medicine, Saku Central Hospital Advanced Care Center, 3400-28 Nakagomi, Saku, Nagano, Japan.

Retropharyngeal hematoma following blunt cervical spine injury is a known cause of airway obstruction, but it is not known to cause hemorrhagic shock. We report the case of a massive retropharyngeal hematoma caused by a blunt vertebral artery transection leading simultaneously to airway obstruction and hemorrhagic shock. An 83-year-old woman was injured in a motorcycle accident. Read More

BMJ Case Rep 2016 Sep 20;2016. Epub 2016 Sep 20.

Department of Otolaryngology, Morriston Hospital, Swansea, UK.

An 11-month-old boy presented with a 2-day history of non-specific symptoms and a zygomatic haematoma. With aetiology uncertain after admission clerking and blood tests, a CT head scan was arranged for suspected traumatic injury and revealed a retropharyngeal abscess (RPA) with significant airway narrowing in the transverse plane. The patient received urgent intraoral abscess drainage and bilateral tonsillectomy in theatre. Read More

Masui 2016 08;65(7):672-677

Stellate ganglion block (SGB) is a commonly used safe procedure. In rare cases, it is associated with life- threatening complications [retropharyngeal hematomas (RPH), local anesthetics-induced toxicity, et al.). Read More

J Craniofac Surg 2016 Jul;27(5):1282-5

West Bloomfield, MI.

This article aims to bring attention to the morbidity and fatality of hemorrhage, how expanding hematoma and air compromise neck/face N/F injuries and present challenges. Large neck vessel ballistic injuries may lead to hemorrhage and expanding hematoma, resulting in airway compromise, due to injuries to the internal and/or external carotid arteries, internal jugular veins "internal carotid artery, external carotid artery, internal jugular vein," and the external carotid artery deep branches. This also leads to injuries to the cervical fascial layers (barriers of deep spaces) that facilitate pooling blood and hematoma into compartmental and large potential space which effects the pharynx, larynx, esophagus, and trachea. Read More

Orthop Traumatol Surg Res 2016 06 20;102(4):485-8. Epub 2016 Apr 20.

Service de Chirurgie Orthopédique, Unité Rachis, CHU de Bordeaux, 33000 Bordeaux, France; Université Bordeaux 1, Bordeaux, France.

Introduction: Anterior cervical spine surgery is a frequent and effective procedure; complications are rare, but potentially fatal. The objective of the present study was to assess epidemiology and risk factors for early reintervention in anterior cervical spine surgery.

Methods: A retrospective case-control study recruited 2319 patients operated on in our department, with 7 years' follow-up. Read More

Case Rep Emerg Med 2015 24;2015:789076. Epub 2015 Dec 24.

Department of Emergency Medicine, Lehigh Valley Hospital and Health Network, USF MCOM, CC & I-78, Allentown, PA 18103, USA.

Inferior thyroid artery (ITA) rupture is rare and may progress to life-threatening conditions. We present a patient who visited the emergency department after an episode of syncope and dizziness in which he had a mechanical fall that resulted in abrasions and a hematoma to his left forehead. The patient presented with dysphagia and anterior neck swelling that progressed rapidly into airway compromise requiring endotracheal intubation. Read More

N Engl J Med 2016 Jan;374(3):e3

University of Toronto, Toronto, ON, Canada

A 56-year-old man presented to the emergency department with a 5-hour history of throat swelling and pain and difficulty breathing that was exacerbated by supine positioning; he had not had any obvious antecedent trauma. His medical history included prostate cancer, hypertension, hyperlipidemia, deep-vein thrombosis, and stroke. Medications included warfarin (presumably for deep-vein thrombosis), antihypertensive agents, and a statin. Read More

N Am J Med Sci 2015 Nov;7(11):494-502

Department of Internal Medicine, Reading Health System, West Reading, Pennsylvania, USA.

Upper airway hematoma (UAH) is a rare but life-threatening complication of oral anticoagulants requiring early recognition. However, no consensus exists regarding the best approach to treatment. We therefore, sought to systematically review the published literature on UAH to elaborate its demographic and clinical characteristics, treatment, complications, and outcomes. Read More

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2015 Jul;50(7):597-8

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J Bronchology Interv Pulmonol 2016 Jul;23(3):239-41

*Michigan State University College of Human Medicine, Grand Rapids †Neurosurgery Department ‡Otolaryngology Department §Radiology Department, Munson Medical Center, Traverse City ∥Pulmonology Department, Henry Ford Health System, Detroit, MI.

Retropharyngeal hematomas (RHs) represents a rare airway obstruction that requires timely intervention to avoid a fatal outcome. Further complicating this malady, RHs of massive proportions can complicate the decision of management selection. After comprehensive literature search, there has been no mention of pulmonary stenting as an intervention for RH. Read More

J Korean Neurosurg Soc 2015 Sep 30;58(3):304-7. Epub 2015 Sep 30.

Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Only a few cases of anterior longitudinal ligament (ALL) injury related with retropharyngeal hematoma without fracture have previously been reported. The treatment of choice for retropharyngeal hematoma is generally considered to be conservative care, but we believe that early surgery of this pathology would be better in certain situations. Here, we describe two cases with life-threatening large retropharyngeal hematomas related with ALL injuries and operated on at an early stage. Read More

BMC Vet Res 2015 Oct 9;11:257. Epub 2015 Oct 9.

Veterinary Teaching Hospital, University of Extremadura, Avda, Universidad s/n, Cáceres, 10003, Spain.

Background: Retropharyngeal hematoma is a rare condition that is difficult to diagnose and may progress rapidly to airway obstruction. The authors report the first known case of acute upper airway obstruction resulting from retropharyngeal hematoma in a dog. Documented causes in human medicine have included coagulopathic states, trauma, infection, parathyroid adenoma rupture, and foreign body ingestion. Read More

Ann Emerg Med 2016 05 3;67(5):616-9. Epub 2015 Oct 3.

Department of Pediatric Anesthesiology and Critical Care Medicine, Asklepios Klinik Sankt Augustin, German Pediatric Heart Center, Sankt Augustin, Germany.

We report a rare case of acute upper airway obstruction caused by spontaneous retropharyngeal hemorrhage as a result of hemophilia A in a 16-year-old pediatric patient who routinely received factor VIII replacement. Initial diagnosis was delayed because the patient presented with symptoms, such as throat pain and odynophagia, similar to those of common benign upper airway infections. Within 2 days of the initial presentation of symptoms, the patient went into respiratory failure as a result of retropharyngeal hemorrhage. Read More

Rofo 2015 Sep 21;187(9):810-2. Epub 2015 Apr 21.

Acute Med Surg 2016 01 12;3(1):43-45. Epub 2015 May 12.

Department of General Thoracic Surgery Tsuchiura Kyodo General Hospital Ibaraki Japan.

Case: A 77-year-old woman presented with neck swelling and odynophagia following a fall from standing height. She had no history of antiplatelet or anticoagulant use. Computed tomography of the chest showed an isodense to hypodense soft tissue mass in the bilateral carotid space, retropharyngeal space, and posterior mediastinum. Read More

BMJ Case Rep 2015 Mar 10;2015. Epub 2015 Mar 10.

Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.

Retropharyngeal 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-year-old 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. Read More

A A Case Rep 2014 Nov;3(9):123-5

From the *Department of Anesthesiology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts; †Otolaryngology Resident, University of Connecticut School of Medicine, Farmington, Connecticut; and ‡Department of Otolarngology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts.

We describe a patient who developed a hypopharyngeal mass (in the setting of a cervical osteophyte) while taking clopidogrel and aspirin for coronary artery disease. He had a 2-month history of progressive dysphagia and hoarseness. Physical examination and computed tomography scan revealed a soft tissue retropharyngeal mass of unclear etiology yet with a stable airway. Read More

Turk J Emerg Med 2014 Dec 2;14(4):182-4. Epub 2016 Mar 2.

Department of Emergency Medicine, Tepecik Training and Research Hospital, Izmir.

Retropharyngeal hematoma due to anticoagulant usage is a rare, life-threatening situation which must be immediately diagnosed and treated. Immediate control of the airway and coagulopathy are the bases of treatment management. Patients often respond to conservative treatment but occasionally urgent tracheostomy and endotracheal intubation may be necessary. Read More

J Forensic Sci 2014 Sep 24;59(5):1427-31. Epub 2014 Jun 24.

Service de Médecine Légale, CHU Toulouse-Rangueil, 1 Avenue Professeur Jean Poulhès, Toulouse Cedex 9, 31059, France.

A 53-year-old woman suffering from radicular pain due to cervical herniation underwent a spinal surgery consisting of anterior cervical discectomy and fusion with an implantable titanium cage. Five hours after the procedure, the patient developed cervical swelling and dyspnea. An emergency surgery permitted evacuation of a deep cervical hematoma and intubation of the patient, who died some minutes later. Read More

J Cardiothorac Surg 2013 Dec 27;8:232. Epub 2013 Dec 27.

Department of Cardiovascular Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo 181-8611, Japan.

Background: Retropharyngeal hematoma is a rare form of pharyngeal pathology and can present as acute airway obstruction. Among the many causes of retropharyngeal hematoma, thoracic aortic rupture is extremely rare.

Methods And Results: A 78-year-old female with airway obstruction by a retropharyngeal hematoma secondary to thoracic aortic aneurysm rupture was successfully treated by total aortic arch replacement and open stent-graft insertion. Read More

Spine (Phila Pa 1976) 2014 Feb;39(4):E246-52

From the Cervical Spine Service, Washington University, Department of Orthopedics, St. Louis, MO.

Study Design: Retrospective review of prospective database.

Objective: To investigate risk factors involved in the development of anterior cervical hematomas and determine any impact on patient outcomes.

Summary Of Background Data: Postoperative (PO) hematomas after anterior cervical spine surgery require urgent recognition and treatment to avoid catastrophic patient morbidity or death. Read More

Anesth Pain Med 2013 1;2(3):134-7. Epub 2013 Jan 1.

Department of Anesthesiology, Clement Zablocki VA Medical Center, Medical College of Wisconsin, Milwaukee, USA.

Ultrasound guidance for pain interventions is becoming increasing recognized as a useful imaging tool. One of the common interventions where it is gaining wider acceptance is during the performance of a stellate ganglion block. The following is a unique report where intravascular and neuronal injury occurred during the performance of an ultrasound guided stellate ganglion block followed by dysphagia. Read More

Spine J 2013 Oct 8;13(10):e39-42. Epub 2013 Aug 8.

Department of Neurosurgery, Istanbul Educational and Research Hospital, Istanbul, Turkey. Electronic address:

Background Context: To report a unique case of an unexpected complication of occipitocervical stabilization surgery that is retropharyngeal hematoma (RH).

Purpose: Postoperative RH is a very rare complication and has never been reported after posterior occipitocervical surgery.

Study Design: Case report. Read More

Interact Cardiovasc Thorac Surg 2013 Jul 21;17(1):179-80. Epub 2013 Mar 21.

Oxford Oesophagogastric Centre, Churchill Hospital, Oxford, UK.

Spontaneous retropharyngeal haematoma and dissecting intramural haematoma of the oesophagus are two distinct, but rare, phenomena. We describe the first case of complete tracheo-oesophageal obstruction due to spontaneous retropharyngeal haematoma presenting with chest pain and dysphagia. Rapid imaging allowed life-saving transfer to the regional specialist centre, with immediate surgical intervention. Read More

Rev Bras Anestesiol 2012 Sep-Oct;62(5):731-5

Karadeniz Technical University, Faculty of Medicine, Department of Anesthesiology and Critical Care, Trabzon, Turkey.

Background And Objectives: The development of a retropharyngeal hematoma following a blunt trauma is a rare occurrence. However, a space-occupying lesion in this area can be life-threatening and requires rapid assessment and treatment. This is clinically important because of the close proximity of the retropharyngeal space to the upper airway. Read More

Head Neck 2013 Sep 21;35(9):E265-8. Epub 2012 Aug 21.

Department of Surgery, Division of Otolaryngology, Huntsman Cancer Institute, Salt Lake City, Utah, USA.

Background: Patients with parathyroid adenomas (PAs) are commonly encountered in otolaryngology and may present with asymptomatic hypercalcemia. Retropharyngeal hematoma and recurrent laryngeal nerve (RLN) paralysis are less commonly encountered presentations and may be harbingers of a malignant process.

Methods And Results: We present 2 patients with rare presentations of parathyroid adenoma. Read More

Turk Neurosurg 2012 ;22(4):521-3

Gazi University, Faculty of Medicine, Division of Pediatric Neurosurgery, Department of Neurosurgery, Ankara, Turkey.

Whiplash Associated Disorders (WAD) has been reported as an adult phenomenon. Whiplash injury has classically been described as a cervical soft tissue hyperextension- flexion injury after a trauma such as a rear end impact car crash, contact sport injuries, blows to the head from a falling object or a punch and shaken baby syndrome and is mostly seen in adults . It is important as it may cause severe disability due to spinal cord injury, decrease work productivity and even retropharyngeal hematoma resulting airway obstruction and mortality due to bleeding amongst deep cervical fascias. Read More

J Emerg Med 2012 Sep 25;43(3):451-6. Epub 2012 Feb 25.

Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Kanagawa, Japan.

Background: Retropharyngeal hematomas are often associated with blunt cervical spine injury. Generally, they improve with conservative treatment; however, rarely, airway obstruction occurs due to delayed swelling of retropharyngeal hematoma.

Objectives: To report a case of sudden asphyxia due to retropharyngeal hematoma caused by blunt thyrocervical artery injury. Read More

ANZ J Surg 2011 Oct;81(10):756

Auris Nasus Larynx 2012 Oct 6;39(5):527-30. Epub 2011 Nov 6.

Department of Otorhinolaryngology, Mitsui Memorial Hospital, Tokyo, Japan.

A case of a spontaneous retropharyngeal hematoma in a patient on chronic hemodialysis is described. A 75-year-old man presented with a 5-day history of throat discomfort and neck swelling. He had been on hemodialysis for chronic renal failure with secondary hyperparathyroidism. Read More

Middle East J Anaesthesiol 2011 Feb;21(1):125-7

Department of Anesthesiology, Nara Medical University, 840 Shijo-cho Kashihara Nara 634-8522, Japan.

A 60 yr-old male underwent anterior cervical fusion under general anesthesia. Neck swelling was observed at the next morning. Subsequently, emergent CT scanning was performed, which revealed a retropharyngeal hematoma narrowing the upper airway and right anterior neck hematoma significantly deviating the trachea and larynx. Read More

Ann R Coll Surg Engl 2011 Sep;93(6):e114-6

Royal Glamorgan Hospital, Llantrisant, UK.

Airway compromise following a cervical spine injury is an unusual cause of respiratory distress. We describe a patient who developed a retropharyngeal haematoma that caused dysphagia, dysarthria and acute airway compromise seven days following a fall, with no other signs of cervical spine injury. The patient was found to have a type 2 fracture through the junction of the odontoid peg and body of C2 with an associated prevertebral haematoma and soft tissue oedema. Read More

Emerg Med J 2011 Sep;28(9):806-8

Department of Otorhinolaryngology-Head and Neck Surgery, University of Freiburg, Freiburg, Germany.

An otherwise healthy 92-year-old woman was admitted to our department with shortness of breath and dysphagia 10 h after a fall in her bathroom. Medical checkup at another institution had not uncovered the causation of the complaints. Clinical and radiological examinations at our department then revealed an expanding retropharyngeal and prevertebral haematoma. Read More

Anaesth Intensive Care 2011 Jul;39(4):768-70

Laryngoscope 2010 ;120 Suppl 4:S179

The majority of retropharyngeal hematomas described in the literature have been associated with anticoagulation therapy, tumors, aneurysm, infection or cervical spine injury. We present a case of a 55-year-old African American female with acute chest pain, sore throat, and dysphagia. Her past medical history was significant for uncontrolled hypertension and cervical spine arthritis. Read More

Pediatr Emerg Care 2011 Jan;27(1):32-3

Graduate Medical Education, University of South Florida, Tampa, FL 33701, USA.

We describe the clinical presentation, radiographic findings, management, and outcome of nontraumatic spinal epidural hematoma in a 10-month-old male infant with severe hemophilia (<1% activity). This patient presented with torticollis, and the differential diagnosis included intramuscular hemorrhage, retropharyngeal abscess, muscle spasm, and epidural hematoma. A computed tomography scan revealed extensive spinal epidural hematoma from C1-L4. Read More

J Surg Case Rep 2011 Oct 1;2011(10). Epub 2011 Oct 1.

The Royal Melbourne Hospital, Victoria, Australia.

Retropharyngeal haematoma is a rare and potentially fatal cause of airway obstruction. The treatment of retropharyngeal haematoma is contentious. We report a case of an 84 year old woman on aspirin and warfarin who developed a retropharyngeal haematoma following minor blunt head and neck trauma. Read More

BMJ Case Rep 2011 Feb 15;2011. Epub 2011 Feb 15.

Department of Otorhinolaryngology - Head and Neck Surgery, University of Freiburg, Freiburg, Germany.

An otherwise healthy 92-year-old woman was admitted to our department with shortness of breath and dysphagia 10 h after a fall in her bathroom. Medical checkup at another institution had not uncovered the causation of the complaints. Clinical and radiological examinations at our department then revealed an expanding retropharyngeal and prevertebral haematoma. Read More

Acta Otorrinolaringol Esp 2012 Jan-Feb;63(1):77-8. Epub 2010 Nov 30.

Servicio de Otorrinolaringología, Hospital Virgen de la Luz, Cuenca, España.