Retropharyngeal hematomas

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.

Delayed retropharyngeal hematoma following a minor facial blunt trauma

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.

A retropharyngeal-mediastinal hematoma with supraglottic and tracheal obstruction: The role of multidisciplinary airway management

A 77-year-old man suffered hypoxemic cardiac arrest by supraglottic and tracheal airway obstruction in the emergency department. A previously unknown cervical fracture had caused a traumatic retropharyngeal–mediastinal hematoma. A lifesaving surgical emergency tracheostomy succeeded. Supraglottic and tracheal obstruction by a retropharyngeal–mediastinal hematoma with successful resuscitation via emergency tracheostomy after hypoxemic cardiac arrest has never been reported in a context of trauma. This clinically demanding case outlines the need for multidisciplinary airway management systems with continuous training and well-implemented guidelines. Only multidisciplinary staff preparedness and readily available equipments for the unanticipated difficult airway solved the catastrophic clinical situation.

Life-threatening airway obstruction presenting as a simple mechanical fall

Emergency medicine requires an ability to manage the undifferentiated patient, often under pressure and with limited or conflicting information. Advanced airway management is an integral component of emergency care but is only one of a broad range of cross-specialty skills used in daily practice. This case demonstrates these factors, while describing a precipitous presentation of a rare clinical problem.

[Severe upper airway obstruction due to retropharyngeal haematoma formation following cervical trauma]

Mechanical airway obstruction secondary to retropharyngeal bleeding is rare. In most cases such a complication is described after head and neck trauma. Complicating factors include anticoagulant therapy, tumour, aneurysm, infection or major cervical spine injury. A precise initial diagnosis is necessary to avoid a life-threatening situation. Lateral X-ray and computed tomography is essential for safe management.Treatment depends upon size of the haematoma as well as the clinical course of the patient. Smaller haematomas may be observed. Lager haematomas and those that fail to reabsorb should undergo drainage.

Traumatic retropharyngeal hematoma: case report

Traumatic retropharyngeal hematoma is a rare but potentially life-threatening condition that requires an early diagnosis. Isolated retropharyngeal hematoma without an associated cervical fracture is a relatively rare condition. The treatment of retropharyngeal hematoma is conservative in most cases, with close observation. The indications for surgical evacuation of hematomas are large size, difficult with mechanical ventilation and failure to improve with medical therapy. We present the case of a 50-year-old man with retropharyngeal hematoma with a compromised airway due to minor contusion of the neck, which required surgical intervention. The patient underwent emergent surgical debridement and tracheostomy. Postoperative course was uneventful. The patient was discharged 9 days later. Early surgical intervention can reduce the hospital stay, resulting in a rapid convalescence.

Traumatic retropharyngeal hematoma: a rare and critical pathology needed for early diagnosis

Retropharyngeal hematoma occurs rarely. It is located just in front of the cervical spine. Many circumstances can lead to its development. A trauma and/or anticoagulants are often key factors. The assessment must be made extremely carefully as such a hematoma can induce an airway compromise. Trauma being a key factor, it can also present with cervical spine fractures, increasing the risks. Two different cases of retropharyngeal hematomas are reported. The first case required surgical management with tracheotomy, per-oral drainage and naso-gastric tube feeding. A total recovery was obtained in 2 weeks. The second patient underwent medical treatment (methylprednisolone), and recovery was obtained in 6 days. Surgery for retropharyngeal hematoma is not always mandatory. It becomes necessary when a major dysphagia or dyspnea occurs. In other cases, medical treatment and close observation are usually sufficient.

Traumatic retropharyngeal hematoma and prevertebral edema induced by whiplash injury

Whiplash injury commonly results in cervical spine trauma. We report a case of a 58-year-old man, who sustained a whiplash injury from contact with the headrest of his seat after his car was involved in a rear-end collision. He presented with sore throat, hoarseness, difficulty in swallowing and progressing dyspnea. The diagnostic work-up comprising lateral radiograph, CT and MR imaging disclosed the rare constellation of a retropharyngeal hematoma and prevertebral edema without further injury of the cervical spine structures. Compression of the upper airways was evident. A careful history and an appropriate diagnostic approach are essential for the work-up and management of such a life-threatening situation.

Traumatic retropharyngeal haematoma treated by embolization of the thyrocervical trunk

Trauma involving the retropharyngeal space is relatively infrequent. Upper airway obstruction due to a retropharyngeal haematoma can be life threatening and requires immediate intervention. We present a well-documented case that illustrates the unexpected clinical course of such a haematoma and its management.

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.

Prevertebral soft-tissue measurements in cervical spine injury

To clarify normal values for cervical prevertebral soft-tissue measurements and evaluate when they are useful as a marker of cervical spine injury, the prevertebral soft-tissue measurements of 79 control and 57 acutely injured patients were retrospectively compared by two independent observers. The second, blinded, observer made a provisional diagnosis and indicated if increased soft-tissue measurements had assisted in making a diagnosis of injury. If measurements > 7 mm at C2/3 and > 21 mm at C6/7 were considered abnormal, a true positive rate of 53% and false positive rate of 5% were observed. The differences between the mean measurements in the control and injured groups were statistically significant (P < 0.0001 at C2/3 and P < 0.01 at C6). Soft-tissue measurement improved the diagnostic confidence of the blinded second reviewer in 17.5% of the injured group. Analysis of this subgroup revealed a 50% error rate in initial reporting. In all of these cases, the abnormal soft-tissues had been ignored prospectively Routine measurement of the prevertebral soft tissues is a simple procedure that may provide an important due to subtle cervical spine injury.

Subglottic airway hemorrhage associated with idiopathic thrombocytopenic purpura

A case of subglottic airway hemorrhage in a 6-year-old child with acute idiopathic thrombocytopenic purpura is presented. No previous cases have been reported in which idiopathic thrombocytopenic purpura was associated with this life-threatening complication. In this case, stridor responded to racemic epinephrine and oxygen. Emergency physicians and pediatricians should be aware of this rare complication.

Minor trauma--major problem. Neck injuries, retropharyngeal haematoma and emergency airway management

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Occipital condyle fracture presenting as retropharyngeal hematoma

Reported is the case of a 30-year-old male motorcycle accident victim who was found on plain cervical-spine radiography to have prevertebral soft-tissue swelling. Although subsequent computed tomography demonstrated no cervical-spine fracture, it did reveal a fracture of one occipital condyle. The mechanism, diagnosis, and treatment of occipital condyle fractures are reviewed, as is the ligamentous and fascial anatomy of the cervicocranium. Dissection of fracture hematoma inferiorly along vertically oriented tissue planes is hypothesized as the pathogenesis of our patient's retropharyngeal hematoma. In addition to being a sign of potential cervical-spine injury, post-traumatic prevertebral soft-tissue swelling may also indicate occipital condyle fracture. To avoid overlooking such fractures, computed tomography undertaken to investigate upper cervical-spine prevertebral soft-tissue swelling should always include slices up to the level of the basal skull so as to visualize the condyles.