Life-threatening retropharyngeal haematoma

Forensic evaluation of fatal-suffocating retropharyngeal haematoma secondary to cervical fractures: Report of two cases

PURPOSE

Traumatic retropharyngeal haematoma, a condition of low incidence, often occurs secondary to cervical injuries. Owing to the adjacent anatomical location and its insidious formation, retropharyngeal haematoma is prone to cause airway obstruction, which can occasionally be fatal. Though well known in clinical practice, retropharyngeal haematomas are rarely encountered in forensic practice and are not sufficiently explored from a forensic perspective.

CASE PRESENTATION

Herein, we present two cases of fatal-suffocating retropharyngeal haematoma following cervical vertebral fractures. In both cases, the time from injury to death was evident, showing unusually long periods from injury to death, specifically 4 days and 2 days, respectively. The causes of death were illustrated, and the delayed onset of fatal airway obstruction was explained. The important points regarding autopsies suspected to be fatal traumatic retropharyngeal haematomas were discussed.

CONCLUSIONS

Knowledge of the possibility of late onset and understanding of the features of imaging and autopsy findings of traumatic retropharyngeal haematoma is beneficial for forensic pathologists dealing with similar cases.

Surgical Treatment of a Life-Threatening Large Retropharyngeal Hematoma after Minor Trauma : Two Case Reports and a Literature Review

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. Two previously healthy patients visited the emergency room with neck pain and dyspnea after falling. Serious neck swelling was observed and lateral neck X-ray showed severe widening of the prevertebral space. Due to dyspnea progression, emergency endotracheal intubation was performed. Although there was no primary cause of the retropharyngeal hematoma on preoperative examination, ALL tearing was intraoperatively confirmed during early surgery. The in-hospital evolutions of the patients were favorable after surgery. We should bear in mind the possibility of ALL injury and perform early surgery where possible given the earlier convalescence and good prognosis.

Life-threatening airway obstruction caused by a retropharyngeal haematoma

We present the case of a 68-year-old woman who had a large cervicomediastinal haematoma that caused life-threatening airway obstruction. Retropharyngeal haematoma may occur in any age group and following a variety of causes. Retropharyngeal haematomas must be considered as a cause of airway obstruction following common injuries such as blunt cervical trauma or internal jugular vein cannulation. A high index of suspicion and early lateral neck X-ray is essential for safe management of this rare but potentially life-threatening injury.