Retropharyngeal haematoma – an unusual bleeding site in an anticoagulated patient: a case report

Abstract

Introduction: Anticoagulation is used widely for the primary prevention of embolic events in patients with atrial fibrillation. Bleeding is the most common complication with oral anticoagulation. We describe the case of a patient who developed a massive retropharyngeal haematoma after a fall. Whilst the retropharyngeal space is an uncommon site for bleeding complications, it is clinically important as the development of upper airway obstruction may be life threatening.

Sublingual and Supraglottic Haemorrhage as a Complication of Warfarin Therapy

“…2 There is no consensus on the use of systemic steroids or prophylactic antibiotics in patients with upper airway haemorrhage. [2][3][4][5] Antibiotics can be used for abscess formation and when non-resolving haematoma is observed as late complications. 3,5 Our first patient received 10 mg vitamin K1 and 4 unit fresh frozen plasma intravenously.…”

“…The upper airway haemorrhage is clinically important because it may lead to the development of a life threatening upper airway obstruction. [2][3][4][5][6] Presenting s y m p t o m s i n c l u d e s o r e t h r o a t , d y s p h o n i a , odynophagia, dysphagia, hoarseness, drooling, respiratory distress, swelling or bruising of the neck. [2][3][4][5] Optical nasopharyngolaryngoscopy, lateral radiograph of the cervical spine, and computed tomography of the neck and mediastinum can be used to determine the site and extent of haematoma, and its relation to other structures within the neck.…”

“…1 Haemorrhage is the most common and serious complication of anticoagulation therapy, and is commonly observed in gastrointestinal tracts, urinary tracts, central nervous system, subcutaneous tissue, skin, nose, penis, and retroperitoneum. [2][3][4][5] Although upper airway haemorrhage is rare, it is a clinically serious condition as the development of upper airway obstruction may be life threatening. [2][3][4][5][6] We reported two cases with sublingual and supraglottic haemorrhage that developed during oral anticoagulation therapy and the related literature was reviewed.…”

A Case of Spontaneous Spinal Epidural Haematoma in the Emergency Department Associated with Warfarin Therapy

“…The initial laboratory findings were: thrombocytes 151,000/uL (normal 165-352), glucose 148 mg/dL (normal 70-110), prothrombin time 82.5 sec (normal [10][11][12][13][14], and international normalised ratio (INR) 7.81 (normal 0.85-1.15); and other findings were within normal limits. The electrocardiogram showed atrial fibrillation with normal axis and intervals and no ischemic changes; the chest radiograph had a normal pericardial silhouette and normal lung fields without infiltrates.…”

Surgical Treatment of a Life-Threatening Large Retropharyngeal Hematoma after Minor Trauma : Two Case Reports and a Literature Review

“…Typically, retropharyngeal hematomas have been reported to be related with anticoagulant therapy, iatrogenic injury, infections, foreign body ingestion, and vascular lesions 1 4 5 6 14 16 18 20) . Although major trauma, such as cervical spinal fracture, has caused retropharyngeal hematomas 6 10 17) , minor trauma is rarely related with a large retropharyngeal hematoma, and only a few cases of anterior longitudinal ligament (ALL) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20) injury related with retropharyngeal hematoma without fracture have previously been reported 7 9 12 13 15) .…”