Successful management of retropharyngeal hematoma by trans-arterial embolism without intubation

Sugiura, G; Takahashi, Hiroyuki; Kodama, Yoshihisa; Nara, Satoshi

doi:10.1186/s12245-020-00322-9

Cited by 5 publications

(5 citation statements)

References 11 publications

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“…In previous studies, tracheotomy was performed within four days in all the patients evaluated. [7,17] Some studies used follow-up imaging or direct observation of the hematoma by laryngoscopy to decide whether to perform tracheotomy [12,18,20]. The present study showed that more than 40% of patients needed to be transferred to other hospitals for rehabilitation.…”

Section: Clinical Implementationmentioning

confidence: 71%

“…In previous studies, tracheotomy was performed within four days in all the patients evaluated. [ 7 , 17 ] Some studies used follow-up imaging or direct observation of the hematoma by laryngoscopy to decide whether to perform tracheotomy [ 12 , 18 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…The rates of intubation and tracheotomy were also similar to those in the current study. In previous studies, data on the discharge site were available in only a few cases [18][19][20].…”

Section: Comparisonmentioning

confidence: 99%

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Traumatic retropharyngeal hematoma without spinal cord injury or spinal fracture: a retrospective multicenter analysis

Shiba

Hifumi

Tomiyama

et al. 2022

Eur J Trauma Emerg Surg

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Background Retropharyngeal hematoma can be a life-threatening injury due to progressive upper airway obstruction. It is common following spinal cord injury or spinal fracture, and the clinical course and outcome of such patients are determined by their primary injuries. However, the natural clinical course of retropharyngeal hematoma itself remains unclear. In this study, we aimed to examine the clinical characteristics of traumatic retropharyngeal hematoma without spinal cord injury or spinal fracture (TREWISS). Methods We performed a multicenter retrospective analysis of patients who were diagnosed in the emergency department with soft tissue swelling of the retropharyngeal space by neck CT, between April 2010 and April 2020. The inclusion criterion was thickness of the retropharyngeal space > 7 mm at C1–C4 or > 22 mm at C5–C7 on a CT image. The exclusion criteria were (1) age < 18 years, (2) cardiopulmonary arrest, (3) other causes of soft tissue swelling besides hematoma, (4) patients with cervical spinal cord injury or spine fractures. Baseline characteristics were compared between intubated and non-intubated patients. Results Twenty-two patients were included in the analysis. Among them, 16 patients needed intubation. Median patient age was 69 years, and 27% of the patients were on antiplatelet or anticoagulant medications. The width of the hematoma on sagittal CT images was significantly wider in the intubated group [median (interquartile range), 2.5 cm (2.0–3.4) vs. 1.2 cm (0.9–1.7), p = 0.002). More than half the intubated patients needed tracheotomy. Tracheotomy was performed around day 3, and endotracheal tube was placed about 3 weeks. Only 60% of patients were successfully discharged to their homes, and one patient (6.3%) died during hospitalization. Conclusion Early intubation and subsequent intensive care are important for patients with TREWISS. The patients typically require several weeks of hospitalization, although their outcomes are usually poor. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-022-02203-7.

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Section: Clinical Implementationmentioning

confidence: 71%

“…In previous studies, tracheotomy was performed within four days in all the patients evaluated. [ 7 , 17 ] Some studies used follow-up imaging or direct observation of the hematoma by laryngoscopy to decide whether to perform tracheotomy [ 12 , 18 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

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Traumatic retropharyngeal hematoma without spinal cord injury or spinal fracture: a retrospective multicenter analysis

Shiba

Hifumi

Tomiyama

et al. 2022

Eur J Trauma Emerg Surg

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“…Because hematoma formation leads to airway obstruction, tracheal intubation should be considered [1,4]. In previous reports, some patients did not require intubation [3,5]. Still, others required intubation five to 20 hours after admission, often when patients did not need intubation at presentation to the emergency department [6,7].…”

Section: Discussionmentioning

confidence: 99%

Awake Fiberoptic Tracheal Intubation in a Patient With Traumatic Retropharyngeal Hematoma

Kani,

Yoshimura,

Ikeda

et al. 2023

Cureus

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Retropharyngeal hematoma is a rare disease triggered by neck trauma and can result in airway obstruction, requiring early recognition and consideration of tracheal intubation. We present a case of a 42-year-old woman brought to the emergency department with dyspnea after a traffic trauma, and a mild stridor was heard on cervical auscultation, indicating airway compromise. Contrast-enhanced computed tomography (CT) scan showed retropharyngeal hematoma. Considering her obesity and short neck, we performed awake fiberoptic intubation successfully without any complications. Awake fiberoptic intubation, directly confirming anatomic abnormalities, may increase the success rate of intubation and prevent complications, especially in patients at high risk for cannot intubate, cannot ventilate (CICV). Cervical auscultation may contribute to early diagnosis and treatment for airway obstruction in patients with cervical trauma. We report a case of awake fiberoptic tracheal intubation for a retropharyngeal hematoma in a patient at high risk for CICV and cervical auscultation in a primary survey.

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“…There have been a few reports of VA injury as a possible source of RH [8,9]. Sugiura et al introduced seven cases of RH for which conventional angiography was performed [10]. In 6 cases, transarterial embolization was effective in controlling retropharyngeal hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

High-energy blunt traumatic vertebro-vertebral arteriovenous fistula with retropharyngeal hematoma: A case report

Yoshihara,

Yamamura,

Okubata

et al. 2023

Preprint

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Background We report a rare case of high-energy blunt traumatic vertebro-vertebral arteriovenous fistula (VV-AVF) with retropharyngeal hematoma (RH) following C2 vertebral fracture after a traffic accident. Although there is currently no established guideline to treat blunt traumatic VV-AVF, effective transarterial embolization to sacrifice the parent artery succeeded in complete obliteration of the VV-AVF with no ischemic complications. Case presentation A 74-year-old woman injured in a traffic accident was transferred to our hospital by ambulance. On arrival, she complained of neck pain and headache. Her respiration and circulation were stable. Computed tomography (CT) revealed a slight subarachnoid hemorrhage, cervical spinal fracture (C2), rib fracture, and thoracic spinal compression fracture. Contrast-enhanced CT showed suspected dissection of her right vertebral artery (VA) at the C2 level. The next day, extravasation from her right vertebral artery at the C2 level was suspected on magnetic resonance angiography, and a thick RH was revealed on a T2-weighted magnetic resonance image. The angiographic study indicated a diagnosis of a high-flow VV-AVF at the C2 level. Transarterial embolization with coils was performed to sacrifice the parent artery, and n-butyl-2-cyanoacrylate injection significantly reduced flow through the fistula, which succeeded in completely obliterating the fistula at one month after the procedure. Conclusions VV-AVF caused by high-energy blunt trauma is extremely rare, but an upper cervical spine injury may trigger it, and RH may sometimes also occur. Transarterial coil embolization of the parent artery to completely obliterate the fistula is generally considered a reliable treatment in the acute stage. The current lack of a treatment guideline requires the accumulation of additional knowledge on the treatment of high-energy blunt traumatic VV-AVF.

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Successful management of retropharyngeal hematoma by trans-arterial embolism without intubation

Cited by 5 publications

References 11 publications

Traumatic retropharyngeal hematoma without spinal cord injury or spinal fracture: a retrospective multicenter analysis

Traumatic retropharyngeal hematoma without spinal cord injury or spinal fracture: a retrospective multicenter analysis

Awake Fiberoptic Tracheal Intubation in a Patient With Traumatic Retropharyngeal Hematoma

High-energy blunt traumatic vertebro-vertebral arteriovenous fistula with retropharyngeal hematoma: A case report

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