Airway obstruction by a retropharyngeal hematoma secondary to thoracic aortic aneurysm rupture

Abstract

BackgroundRetropharyngeal hematoma is a rare form of pharyngeal pathology and can present as acute airway obstruction. Among the many causes of retropharyngeal hematoma, thoracic aortic rupture is extremely rare.Methods and resultsA 78-year-old female with airway obstruction by a retropharyngeal hematoma secondary to thoracic aortic aneurysm rupture was successfully treated by total aortic arch replacement and open stent-graft insertion.ConclusionRupture of the thoracic aorta should be considered as a rare but important cause of retropharyngeal hematoma and airway obstruction.

A Woman With Neck Swelling and Cardiac Arrest

“…Retropharyngeal hematoma (RPH) due to a nontraumatic TAA rupture is a rare clinical entity that can be life-threatening. 2,3 For this patient, the mode of arrest may be hemorrhagic shock, which was supported by the POCUS signs of hypovolemia that included small left ventricular cavity and collapsible inferior vena cava, or because of respiratory arrest, which could explain the reason that ROSC was achieved soon after successful intubation. In fact, airway compromise due to mass effect has been reported in patients with TAA or RPH.…”

Vertebral artery ruptures manifesting as hoarseness

“…Great vessels such as the thoracic aorta and thyrocervical trunk have also been reported. 1 , 2 Various mechanisms that may lead to traumatic retropharyngeal hematoma have been described: (1) hyperextension when falling on the head, car accidents, exercise including yoga, calisthenics, archery, and even painting a ceiling; (2) direct trauma to the pharyngeal wall by ingestion of foreign bodies, oral intubation, jugular vein cannulation, or cervical surgery. Predisposing factors include older age, coagulation disorders (or anticoagulant medication), vascular lesions, and preexisting vertebral bone deformities.…”

Postintubation airway obstruction caused by a retrotracheal haematoma

“…Retrotracheal haematoma is caused by aortic injuries, bleeding of the mediastinal vein, ruptured aneurysm of the inferior thyroid artery or vertebral fractures 1. It is identified through extravasation on CECT 2.…”