Severe upper airway obstruction due to delayed retropharyngeal hematoma formation following blunt cervical trauma

Abstract

BackgroundWe report a case of severe upper airway obstruction due to a retropharyngeal hematoma that presented nearly one day after a precipitating traumatic injury. Retropharyngeal hematomas are rare, but may cause life-threatening airway compromise.Case presentationA 50 year-old man developed severe dyspnea with oropharyngeal airway compression due to retropharyngeal hematoma 20 hours after presenting to the emergency department. The patient also had a fractured first cervical vertebra and was diagnosed with a left brachial plexopathy. The patient underwent emergent awake fiberoptic endotracheal intubation to provide a definitive airway.ConclusionRetropharyngeal hematoma with life-threatening airway compromise can develop hours or days after a precipitating injury. Clinicians should be alert to the potential for this delayed airway collapse, and should also be prepared to rapidly secure the airway in this patient population likely to have concomitant cervical spinal or head injuries.

Fiberoptic Intubation: An Overview and UpdateDiscussion

“…Other reports have described soft tissue swelling and hematoma causing airway obstruction in patients with cervical spine injuries. 28,29 Fiberoptic techniques permit precise evaluation of such pre-existing injury and can be used to facilitate ETT placement beyond the level of injury. For these reasons, FOI in the spontaneously breathing patient has been previously referred to as the method of choice for airway management in patients with airway trauma.…”

Magnetic Resonance Imaging Changes in the Size and Shape of the Oropharynx Following Acute Whiplash Injury

“…1,3,22 However, the available evidence reports on more severe consequences, such as obvious airway obstruction 22 due to prevertebral edema and retropharyngeal hematoma 1 following blunt cervical trauma. Although these cases provide some potential explanation underlying oropharyngeal size and shape changes, the likelihood of such traumatically induced mechanisms is poor, as none of our subjects, including those with a more severe presentation, reported difficulty with breathing or swallowing, or had documented findings consistent with an acute , and thus the pharyngeal muscle system.…”

“…2 The variability of reported symptoms, including neck pain, complaints of dizziness, otological and ocular disturbances, headache, loss of concentration and short-term memory, anxiety, insomnia, and depression, 1,7,26,[30][31][32][33][34][35] can challenge even the most astute clinician. Further complicating the clinical picture is the presence of less-recognized symptoms, such as hoarseness, difficulty swallowing, 1,22 or voice changes, in chronic whiplash. 3 In general, such symptoms are not commonly associated with a whiplash injury, and the specific underlying causes for such changes are unknown.…”

Severe upper airway obstruction due to retropharyngeal haematoma formation following cervical trauma

“…Als auslösende Faktoren einer Einblutung in den retropharyngealen Raum werden Verletzungen des M. longus colli an der Vorderseite der Wirbelkörper, an dem Ligamentum longitudinale oder an den vorderen Ästen der A. vertebralis diskutiert [7,9,10]. Diese Verletzungen sind häufig assoziiert mit einem Halstrauma unter einer Therapie mit Antikoagulantien.…”

“…Diese Verletzungen sind häufig assoziiert mit einem Halstrauma unter einer Therapie mit Antikoagulantien. Eine Blutung kann aber auch durch stumpfe Traumata, beim Legen eines zentralen Venenkatheder, im Rahmen einer Angiographie, infolge eines Schleudertraumas oder durch das Verschlucken von Fremdkörpern, bei retropharyngealer Infektion, Aneurysma der A. carotis und Metastasen verursacht werden [1,4,5,7,11].…”