Exacerbation of Retropharyngeal Hematoma after Initial Improvement

抄録

Retropharyngeal hematoma is a rare and life-threatening due to the rapid progression of airway obstruction. We herein report a case of exacerbation of retropharyngeal hematoma after initial improvement.

We report the case of a 93-year-old woman who presented to the emergency department complaining of anterior neck swelling. She was diagnosed as retropharyngeal hematoma without a preceding traumatic injury or coagulopathy. Computed tomography (CT) scan showed a hematoma extending from the retropharyngeal to the superior mediastinal space and slight extravasation near the right vertebral artery. She was conservatively managed at the intensive care unit, with improvement in neck size. On post-admission day 21, she suddenly developed dysphagia followed by dyspnea, her oxygen saturation decreased rapidly, and emergency tracheostomy was performed. A CT scan revealed exacerbation of the retropharyngeal hematoma. Twelve days after exacerbation, she moved to the general ward because her condition became stable. On post-admission day 60, she developed bacterial pneumonia, which worsened her respiratory condition. On post-admission day 80, she died of bacterial pneumonia.

On encountering elderly patients with retropharyngeal hematoma-associated airway obstruction without preceding traumatic injury or coagulopathy, airway management and monitoring for hemorrhage are essential.