Spontaneous retropharyngeal haematoma: report of a case

Abstract

Spontaneous retropharyngeal haematoma: report of a casea ns_5862 756..766 Spontaneous retropharyngeal haematoma (SRH) is rare. To our knowledge, only nine cases have been published in the English literature. 1-5 Herein, we report another case of SRH.A 53-year-old man presented to the Emergency Department with a 3-week history of coryza, sore throat and cough. Examinations were unremarkable apart from an erythematous throat. Blood tests showed haemoglobin of 94 g/L but no other abnormalities. Electrocardiogram and chest X-ray were normal. The patient was discharged with presumed upper respiratory tract infection.Overnight, he developed hoarseness and dysphagia, and he represented the next morning. Upon examination, he had obvious neck swelling and right anterior neck ecchymosis. Investigations showed further drop in haemoglobin to 88 g/L. Computed tomography (CT) and magnetic resonance imaging showed a retropharyngeal mass with features consistent with haemorrhage (see Fig. 1). CT aortogram located the source of bleeding from the right inferior thyroid artery and the patient underwent a successful embolization of the thyrocervical trunk. Repeat CT scan 2 months later showed complete resolution of the haematoma.SRH is rare, making diagnosis difficult for the unwary. The Capp's triad (superior mediastinal obstruction, anterior tracheal displacement and neck bruising) is a useful diagnostic criterion to screen for SRH. 1 On the second presentation, the patient demonstrated classic signs and symptoms of Capp's triad, including superior mediastinal obstruction (hoarseness, dysphagia and neck swelling), anterior tracheal displacement on radiological imaging and anterior neck ecchymosis.Management of SRH depends on its cause. In our case, the source of the haemorrhage was identified, leading to successful embolization of the right thyrocervical trunk.In summary, SRH is extremely rare. Capp's triad is a useful diagnostic criterion, and management depends on the cause. References1. Munoz A, Fischbein NJ, de Vergas J, Crespo J, Alvarez-Vincent J. Spontaneous retropharyngeal hematoma: diagnosis by MR imaging. AJNR Am. J. Neuroradiol. 2001; 22: 1209-11. 2. Singh A, Ofo E, Cumberworth V. Spontaneous retropharyngeal haematoma: a case report. J. Med. Case Reports 2008; 2: 8. 3. Taniguchi I, Maeda T, Morimoto K, Miyasaka S, Suda T, Yamaga T. Spontaneous retropharyngeal hematoma of a parathyroid cyst: report of a case. Surg. Today 2003; 33: 354-7. 4. Newton AI. Spontaneous retropharyngeal hematoma: an unusual presentation of thoracic aortic dissection.

Diagnosis and conservative therapy of retropharyngeal hematoma

“…11,16 In cases caused by spontaneous bleeding from large blood vessels, CT-angiography and embolization can be performed. 15 In our patient, a CT scan of the neck without contrast was performed, and the appearance of the mass retropharyngeal mass according to the Hounsfield Unit (HU) was 63-70. This correlated to HU for blood clots, which is 50-75.…”

“…The classic symptom known as Capp's triad consists of superior mediastinal obstruction (hoarseness, dysphagia, and neck edema), protrusion of the trachea anteriorly on radiological findings, and ecchymosis of the anterior neck and chest. 15 To differentiate the symptoms of a hematoma from a retropharyngeal abscess, could be seen from the absence of infection symptoms such as fever, restricted neck movement, increased leukocyte count, and coagulation status. 8,10 In our patient, the symptoms included difficulty of swallowing, which subsequently progressed to shortness of breath and stridor.…”

Hematoma espontáneo de faringolaringe y anticoagulación. Descripción de un caso

“…La incidencia por año de tratamiento es del 4,1-5,2% [3]. El tracto aerodigestivo superior es una localización muy infrecuente, pudiendo presentarse en los espacios submaxilar, sublingual, peritonsilar [1,3], siendo excepcional en la región faringolaríngea (unos 12 casos descritos de hematoma espontáneo) [7,9,13,14], que es donde existe el mayor riesgo obstructivo de la vía aé-rea. El espacio retrofaríngeo es un área de tejido conectivo laxo situado entre la fascia visceral de la faringe y la capa alar de la fascia cervical profunda.…”

Retropharyngeal Hematoma Secondary to Vomiting in a Healthy Adult: A Case Report

“…Spontaneous retropharyngeal hematoma is defined by the absence of any clear etiology. There are only a few case reports in the recent literature [2]. Retropharyngeal hematomas are, although extremely uncommon, associated with a range of conditions including cervical trauma, anticoagulation, bleeding diathesis, following internal jugular vein cannulation, arteriography and carotid sinus massage [3,4].…”