Introduction: Spontaneous Retropharyngeal Hematoma (SRH) is a rare affection which occurs without traumatism. Case report: A 68 years old woman brought to the emergency department with a cervico-thoracic swelling rapidly increasing in size without any previous traumatic history or anticoagulant medication. Complicated by dysphagia and dysphonia without signs of dyspnea. The clinical examination revealed a painful anterior cervico-thoracic swelling with an ecchymotic cupboard on it. Cervico-thoracic CT scan found a voluminous retro-pharyngeal collection, spontaneously hyperdense, extended to the oropharynx and antero-superior mediastinum without further lesions. Biological assessment was without abnormalities. The diagnosis of retropharyngeal hematoma was retained. The treatment was based on corticosteroids and antibiotics drugs with strict clinical and radiological monitoring. With conservative treatment, the evolution was favorable, marked by progressive regression of the hematoma until its disappearance and an absence of recurrence after a retreat of one year. Conclusion: The clinical presentation of a retropharyngeal hematoma out of an evocative context is misleading and lead to radiological investigation without delaying the treatment which varies from supervision to surgery according to respiratory status and evolution under strict control.