Acute airway obstruction due to retropharyngeal haematoma caused by a large fish bone in a patient with hypertension caused by a pheochromocytoma

Wei, Yan; Jahreiß, L. M.; Zhang, Zhi-Li; Albers, Andreas E.

doi:10.1136/bcr-2014-208644

Cited by 4 publications

(3 citation statements)

References 21 publications

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“…FFB more frequently features bleeding than other kinds of FB [ 28 ]. In pharyngeal FFB, deep neck infection, neck abscess, epidural abscess [ 62 ], and retropharyngeal hematoma [ 63 ] are the main complications, and the FFB can migrate through the soft tissue of the neck to the skin [ 64 ]. If the FFB erodes the esophageal mucosa, esophageal dissection and intramural hematoma [ 65 , 66 ] or abscess formation could be possible [ 67 ].…”

Section: Fish Bone Foreign Body In the Esophagus And Pharynxmentioning

confidence: 99%

Oroesophageal Fish Bone Foreign Body

Kim

2016

Clin Endosc

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Fish bone foreign body (FFB) is the most frequent food-associated foreign body (FB) in adults, especially in Asia, versus meat in Western countries. The esophageal sphincter is the most common lodging site. Esophageal FB disease tends to occur more frequently in men than in women. The first diagnostic method is laryngoscopic examination. Because simple radiography of the neck has low sensitivity, if perforation or severe complications requiring surgery are expected, computed tomography should be used. The risk factors associated with poor prognosis are long time lapse after FB involvement, bone type, and longer FB (>3 cm). Bleeding and perforation are more common in FFB disease than in other FB diseases. Esophageal FB disease requires urgent treatment within 24 hours. However, FFB disease needs emergent treatment, preferably within 2 hours, and definitely within 6 hours. Esophageal FFB disease usually occurs at the physiological stricture of the esophagus. The aortic arch eminence is the second physiological stricture. If the FB penetrates the esophageal wall, a life-threatening aortoesophageal fistula can develop. Therefore, it is better to consult a thoracic surgeon prior to endoscopic removal.

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Section: Fish Bone Foreign Body In the Esophagus And Pharynxmentioning

confidence: 99%

Oroesophageal Fish Bone Foreign Body

Kim

2016

Clin Endosc

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“…Today we know that there are many causes of retropharyngeal hematoma, including retropharyngeal abscess, trauma, sudden pressure changes (due to vomiting, coughing and sneezing), foreign body ingestion, surgery, central venous cannulation and carotid aneurysm, portal hypertension, the presence of tumors, and an aberrant artery at the thoracic inlet. Also, spontaneous bleedings in association with anticoagulant therapy or bleeding diatheses are possible causes [6–8].…”

Section: Discussionmentioning

confidence: 99%

Retropharyngeal hematoma in the context of obstructive sleep apnea: a case report and review of the literature

et al. 2019

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Background Obstructive sleep apnea is related to increased systemic inflammation and arterial hypertension. We present a case of retropharyngeal hematoma without trauma und hypothesize that this could be caused by untreated obstructive sleep apnea. Case presentation A 47-year-old white woman with unilateral pharyngeal discomfort presented to our ear, nose, and throat clinic. She had no risk factors for the development of a spontaneous retropharyngeal hematoma, for example, hypertension or coagulation disorder. As she was overweight, the anamnesis included signs of obstructive sleep apnea such as snoring or breathing arrests during the night, which she denied. An endoscopic examination showed a submucosal hemorrhage of the posterior wall of her pharynx. Magnetic resonance imaging revealed a retropharyngeal hematoma without evidence of the injury of any blood vessel. A subsequent seven-channel polygraphy revealed a severe obstructive sleep apnea with an apnea-hypopnea index of 59.5 per hour. She was subsequently treated with auto-titrating continuous positive airway pressure resolving obstructive sleep apnea immediately. Two months after this episode she presented without any complaints. Conclusion In consequence of this case we are convinced that an untreated obstructive sleep apnea can lead to retropharyngeal hematoma.

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“…Pharyngeal FFBs can cause deep neck infection, neck abscess and retropharyngeal hematoma/abscess, estimated at 3%. 15 30 Soft tissue migration of FFBs was also reported to result in esophageal dissection, penetration into the facial artery, floor of mouth hematoma, penetration of the parotid duct, and retropharyngeal abscess. 15 29 30 31 In more severe cases, FFBs can damage the cardiovascular system.…”

Section: Review Of the Literaturementioning

confidence: 99%

Fish Bone Foreign Body: The Role of Imaging

Klein

Tamir

Marom

et al. 2018

Int Arch Otorhinolaryngol

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Introduction Fish bone foreign body (FFB) impaction in the upper aerodigestive tract is a common cause for emergency department referral. Its management varies in both diagnosis and treatment paradigms. Fish bone foreign bodies are more commonly found in the oropharynx in cases of patients < 40 years old, and in the esophagus in cases of patients > 40 years old. Symptoms are typically non-indicative for the location of the FFB, with the exception of foreign body sensation at/superior to the cervical esophagus. A lack of findings during the physical examination is routinely followed by imaging, with computed tomography (CT) being the preferred modality. In practice, many patients undergo unnecessary imaging studies, including CT scans. Objectives To identify patients with suspected fish bone impaction who do not require CT imaging and can be safely discharged. Data Synthesis We have searched the PubMed database for the following medical subject headings (MeSH) terms: fish bone , fish foreign body AND oropharynx , hypopharynx , esophagus , flexible esophagoscopy , and rigid esophagoscopy . Our search in the English language yielded 32 papers. Case reports were included, since they highlighted rare and serious complications. Conclusion In patients > 40 years old suspected of fish bone impaction, non-contrast CT is recommended and should be urgently performed, even in the presence of ambiguous symptoms. However, in patients < 40 years old presenting within 24 hours from ingestion, imaging has little diagnostic value due to the low probability of esophageal fish bones. For this specific subgroup, in the absence of clinical findings, discharge without imaging studies may be considered safe.

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Acute airway obstruction due to retropharyngeal haematoma caused by a large fish bone in a patient with hypertension caused by a pheochromocytoma

Cited by 4 publications

References 21 publications

Oroesophageal Fish Bone Foreign Body

Oroesophageal Fish Bone Foreign Body

Retropharyngeal hematoma in the context of obstructive sleep apnea: a case report and review of the literature

Fish Bone Foreign Body: The Role of Imaging

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