Life-threatening cervico-mediastinal haematoma after carotid sinus massage

Abstract

Retropharyngeal and cervico-mediastinal haematomas are rare but potentially fatal entities. The potential for airway compression necessitates rapid assessment and treatment.A cervico-mediastinal haematoma following carotid sinus massage which required cervical drainage is presented. This is a life-threatening event demanding a high index of suspicion. A review of the literature and indications for treatment are discussed.

Tracheo-oesophageal compression due to massive spontaneous retropharyngeal haematoma

“…In many, however, the initial cause is unclear (although an underlying history of coagulopathy is often found, and abnormal swallowing mechanisms have been postulated for this group) [1]. Retropharyngeal haematoma is most commonly caused by cervical trauma, although instrumentation and sudden pressure changes (due to vomiting, coughing and sneezing) may also be causative [2]. A small subset appears to be spontaneous, although coagulopathy may again contribute.…”

“…Retropharyngeal haematoma typically presents with neck pain and variable tracheal/ oesophageal obstruction [3]. While the majority of cases are minor and managed conservatively, intervention is rarely required for major bleeding, either surgically via thoracotomy, or radiologically via angiography with embolization [1,2,4]. Oesophageal obstruction can be managed endoscopically.…”

An unusual case of dysphagia following routine electrical DC cardioversion

“…Neck haematomas most frequently develop post blunt traumatic injury (3); hyperextension injuries with or without associated cervical fractures appears to be an increasing feature (4). Previous reports have described haematoma formation as the result of trivial factors including coughing, straining as well as occurring spontaneously (5).…”

“…Previous reports have described haematoma formation as the result of trivial factors including coughing, straining as well as occurring spontaneously (5). Other precipitating factors include foreign body ingestion (iatrogenic secondary to instrumentation and laryngoscopy), carotid sinus massage (3) and even acupuncture (6). A raised INR is often a cofounding variable.…”

An evolving difficult airway

“…[1234] We report the case of a 55-year-old moderately built male who developed upper airway obstruction due to retropharyngeal hematoma following a motor vehicle accident. On reaching the emergency department (ED), the patient was restless, agitated, and intoxicated with ethanol.…”