2024 Volume 38 Issue 2 Pages 141-146
Introduction : Retropharyngeal hematoma following head and neck trauma can cause airway obstruction, necessitating tracheal intubation in severe cases. In this report, we describe a case in which a rapidly expanding traumatic retropharyngeal hematoma prompted consideration of tracheal intubation ; however, timely transarterial embolization (TAE) successfully obviated the need for tracheal intubation.
Case report : A 78–year–old man lost consciousness and was urgently admitted to the hospital because of neck pain after a fall. No abnormal neurological or respiratory symptoms were noted during the initial examination. However, subcutaneous hemorrhage was observed in the left anterior neck area. Neck computed tomography (CT) revealed no evident bone fractures but did show a hyperdense area in the retropharyngeal space extending into the mediastinum, on the left side of the neck, and dorsal to the carotid sheath. Based on this finding, a diagnosis of traumatic retropharyngeal hematoma was made. As respiratory abnormalities were absent, the patient was admitted to the hospital for close monitoring. Subsequent imaging revealed progressive enlargement of the hematoma, with contrast–enhanced CT indicating contrast medium extravasation within the hematoma and a pressure deformity of the trachea. In addition, the patient developed dysphagia after admission, which increased the risk of asphyxia because of further hematoma enlargement. Consequently, we opted to perform TAE. Angiography revealed extravasation from the peripheral portion of the inferior thyroid artery. Hemostasis was achieved by injecting Serescue, a hemostatic agent, into the same artery, followed by coil embolization at the origin of the inferior thyroid artery. Following TAE, the patient’s respiratory condition and dysphagia remained stable. Cervical CT performed the day after the TAE showed that the retropharyngeal hematoma had reduced in size. Six days after the TAE, the patient was discharged with mild dysphagia that did not hinder his ability to eat.
Conclusion : While it is reported that the retropharyngeal space is enlarged in 60% of cervical injuries, airway obstruction due to a retropharyngeal hematoma occurs in only 1–2% of such cases. However, this case raised concerns regarding potential future airway obstruction due to the presence of an enlarged hematoma on follow–up imaging, contrast extravasation on contrast–enhanced CT, and mild dysphagia. In patients with retropharyngeal hematoma, early TAE may preclude the need for tracheal intubation, particularly when hematoma growth and contrast extravasation are observed over time, even in the absence of symptoms at the initial examination.
