Spontaneous retropharyngeal haematoma with direct oral anticoagulant medication

Abstract

A 79-year-old man presented to the emergency department following a 1-week history of dyspnoea, dysphonia, dysphagia and a nonproductive cough. Previous medical history included atrial fibrillation, for which he was taking rivaroxaban, hypertension and obstructive sleep apnoea. On assessment, there was a mild stridor, swelling of the anterior aspect of the neck and submandibular bruising. CT of the neck demonstrated prevertebral soft tissue swelling extending from C1 to C6 levels, approximately 88 mm in length with a maximum depth of 25 mm. A diagnosis of spontaneous retropharyngeal haematoma was made: the airway was secured with fibreoptic nasal intubation and the patient admitted to the intensive care unit. Direct and fibreoptic assessment of the airway on day 3 confirmed that the haematoma had significantly reduced in size. The patient was extubated on day 4 and made a good recovery.

A rare cause of neck swelling: Spontaneous bleeding of the bronchogenic cyst

“…Spontaneous bleeding of the head and neck due to anticoagulant use has been reported. [4,8] These were mostly laryngeal, retropharyngeal, and sublingual. [4] Spontaneous bleeding of the parathyroid and thyroid gland has been reported, and it should be kept in mind when a patient presents with neck swelling.…”

Spontant hematom på halsen

“…CT collum viste at hematomet strakk seg retrofaryngealt, uten at dette var synlig i slimhinnen i farynks. I litteraturen er det beskrevet både akutt intubasjon og akutt trakeotomi for å sikre åpne luftveier hos denne pasientgruppen (3,4). Dette ble ikke funnet nødvendig, da respiratoriske parametere var upåfallende.…”