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Alabdulqader AA, Almudawi NA, Alkhonezan SM, Almudawi MA, Alkhonezan MM, Alshehri GA, Alnatheer AM. Traumatic retropharyngeal hematoma: A systematic review of reported cases. Saudi Med J 2024; 45:10-26. [PMID: 38220242 PMCID: PMC10807669 DOI: 10.15537/smj.2024.45.1.20230565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/06/2023] [Indexed: 01/16/2024] Open
Abstract
OBJECTIVES To study the mechanisms of injury, clinical manifestations, radiological findings, management, and outcomes of traumatic retropharyngeal hematoma (RH). METHODS We used the Preferred Reporting Items of Systematic Reviews guidelines to carry out a systematic literature review to identify all published cases of traumatic RH by searching the PubMed database. Articles published between 1988 and 2022 that reported traumatic RH were included. However, articles that reported non-traumatic RHs and non-English articles were excluded from this study. RESULTS Of the 62 articles screened, 56 were included. Most patients (55%) were above the mean age of 61.7. The majority of patients were male (69.7%). The main symptom was dyspnea (66.6%) and symptoms usually presented within 24 hours. Among the patients, 90.9% did not take anticoagulants or have coagulation disorders, and the main injury mechanism was falling (54.5%). Most of the computed tomography findings reported retropharyngeal (38%) and prevertebral (15%) hematoma. Meanwhile, magnetic resonance imaging revealed 2 masses in the retropharyngeal space and 2 RHs. With several treatment modalities, more than 50% of the cases were only observed (44 cases), and endotracheal intubation was the most commonly used airway management method (n=35). CONCLUSION Traumatic RH is often caused by falls, particularly in elderly patients. Dyspnea is the primary symptom, usually appearing within 24 hours. Cervical vertebral fractures are the leading cause, and observation is the most common treatment approach.PROSPERO Reg. No.: CRD42022349010.
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Affiliation(s)
- Abdullah A. Alabdulqader
- From the Department of Otorhinolaryngology-Head and Neck Surgery (Alabdulqader), College of Medicine, Imam Mohmmad Ibn Saud Islamic University; from the Collage of Medicine (N. A. Almudawi, S. M. Alkhonezan, M. A. Almudawi, M. M. Alkhonezan, Alshehri), Imam Mohammad Ibn Saud Islamic University, and from the Department of Emergency Medicine (Alnatheer), King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia.
| | - Norah A. Almudawi
- From the Department of Otorhinolaryngology-Head and Neck Surgery (Alabdulqader), College of Medicine, Imam Mohmmad Ibn Saud Islamic University; from the Collage of Medicine (N. A. Almudawi, S. M. Alkhonezan, M. A. Almudawi, M. M. Alkhonezan, Alshehri), Imam Mohammad Ibn Saud Islamic University, and from the Department of Emergency Medicine (Alnatheer), King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia.
| | - Shahad M. Alkhonezan
- From the Department of Otorhinolaryngology-Head and Neck Surgery (Alabdulqader), College of Medicine, Imam Mohmmad Ibn Saud Islamic University; from the Collage of Medicine (N. A. Almudawi, S. M. Alkhonezan, M. A. Almudawi, M. M. Alkhonezan, Alshehri), Imam Mohammad Ibn Saud Islamic University, and from the Department of Emergency Medicine (Alnatheer), King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia.
| | - Mohammed A. Almudawi
- From the Department of Otorhinolaryngology-Head and Neck Surgery (Alabdulqader), College of Medicine, Imam Mohmmad Ibn Saud Islamic University; from the Collage of Medicine (N. A. Almudawi, S. M. Alkhonezan, M. A. Almudawi, M. M. Alkhonezan, Alshehri), Imam Mohammad Ibn Saud Islamic University, and from the Department of Emergency Medicine (Alnatheer), King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia.
| | - Manal M. Alkhonezan
- From the Department of Otorhinolaryngology-Head and Neck Surgery (Alabdulqader), College of Medicine, Imam Mohmmad Ibn Saud Islamic University; from the Collage of Medicine (N. A. Almudawi, S. M. Alkhonezan, M. A. Almudawi, M. M. Alkhonezan, Alshehri), Imam Mohammad Ibn Saud Islamic University, and from the Department of Emergency Medicine (Alnatheer), King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia.
| | - Ghada A. Alshehri
- From the Department of Otorhinolaryngology-Head and Neck Surgery (Alabdulqader), College of Medicine, Imam Mohmmad Ibn Saud Islamic University; from the Collage of Medicine (N. A. Almudawi, S. M. Alkhonezan, M. A. Almudawi, M. M. Alkhonezan, Alshehri), Imam Mohammad Ibn Saud Islamic University, and from the Department of Emergency Medicine (Alnatheer), King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia.
| | - Abdullah M. Alnatheer
- From the Department of Otorhinolaryngology-Head and Neck Surgery (Alabdulqader), College of Medicine, Imam Mohmmad Ibn Saud Islamic University; from the Collage of Medicine (N. A. Almudawi, S. M. Alkhonezan, M. A. Almudawi, M. M. Alkhonezan, Alshehri), Imam Mohammad Ibn Saud Islamic University, and from the Department of Emergency Medicine (Alnatheer), King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia.
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Shiba D, Hifumi T, Tomiyama K, Tanaka M, Tanaka A, Ogawa K, Hamaguchi M, Iizuka N, Watase A, Shin K, Otani N. Traumatic retropharyngeal hematoma without spinal cord injury or spinal fracture: a retrospective multicenter analysis. Eur J Trauma Emerg Surg 2022; 49:1477-1484. [PMID: 36585980 PMCID: PMC9805348 DOI: 10.1007/s00068-022-02203-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/18/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Retropharyngeal hematoma can be a life-threatening injury due to progressive upper airway obstruction. It is common following spinal cord injury or spinal fracture, and the clinical course and outcome of such patients are determined by their primary injuries. However, the natural clinical course of retropharyngeal hematoma itself remains unclear. In this study, we aimed to examine the clinical characteristics of traumatic retropharyngeal hematoma without spinal cord injury or spinal fracture (TREWISS). METHODS We performed a multicenter retrospective analysis of patients who were diagnosed in the emergency department with soft tissue swelling of the retropharyngeal space by neck CT, between April 2010 and April 2020. The inclusion criterion was thickness of the retropharyngeal space > 7 mm at C1-C4 or > 22 mm at C5-C7 on a CT image. The exclusion criteria were (1) age < 18 years, (2) cardiopulmonary arrest, (3) other causes of soft tissue swelling besides hematoma, (4) patients with cervical spinal cord injury or spine fractures. Baseline characteristics were compared between intubated and non-intubated patients. RESULTS Twenty-two patients were included in the analysis. Among them, 16 patients needed intubation. Median patient age was 69 years, and 27% of the patients were on antiplatelet or anticoagulant medications. The width of the hematoma on sagittal CT images was significantly wider in the intubated group [median (interquartile range), 2.5 cm (2.0-3.4) vs. 1.2 cm (0.9-1.7), p = 0.002). More than half the intubated patients needed tracheotomy. Tracheotomy was performed around day 3, and endotracheal tube was placed about 3 weeks. Only 60% of patients were successfully discharged to their homes, and one patient (6.3%) died during hospitalization. CONCLUSION Early intubation and subsequent intensive care are important for patients with TREWISS. The patients typically require several weeks of hospitalization, although their outcomes are usually poor.
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Affiliation(s)
- Daiki Shiba
- Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-8560 Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-8560 Japan
| | - Koichiro Tomiyama
- Department of Emergency Medicine and Critical Care, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo 162-8655 Japan
| | - Masaou Tanaka
- Emergency and Critical Care Medicine Department, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama 641-0012 Japan
| | - Atsuhito Tanaka
- Department of Emergency and Critical Care Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minamimachi, Chuo-Ku, Kobe, Hyogo 650-0047 Japan
| | - Kenji Ogawa
- Department of Orthopaedic Surgery, National Hospital Organization Ureshino Medical Center, 4279-3 Ureshino-Cho, Ureshino, Saga 843-0393 Japan
| | - Mitsuhide Hamaguchi
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Kindai University, 377-2 Ohnohigashi, Osakasayama, Osaka 589-8511 Japan
| | - Narusato Iizuka
- Emergency and Critical Care Center, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602 Japan
| | - Akira Watase
- Department of Emergency Medicine and Critical Care, Tokyo Medical Center, 2-5-1 Higashigaoka, Meguroku, Tokyo 152-8902 Japan
| | - Kijong Shin
- Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-8560 Japan
| | - Norio Otani
- Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-8560 Japan
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