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Severe upper airway obstruction due to delayed retropharyngeal hematoma formation following blunt cervical trauma.

Lazott LW, Ponzo JA, Puana RB, Artz KS, Ciceri DP, Culp WC - BMC Anesthesiol (2007)

Bottom Line: The patient also had a fractured first cervical vertebra and was diagnosed with a left brachial plexopathy.Retropharyngeal hematoma with life-threatening airway compromise can develop hours or days after a precipitating injury.Clinicians should be alert to the potential for this delayed airway collapse, and should also be prepared to rapidly secure the airway in this patient population likely to have concomitant cervical spinal or head injuries.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anesthesiology, The Texas A&M University System Health Science Center College of Medicine, Scott & White Hospital, Temple, Texas, USA. llazott@swmail.sw.org

ABSTRACT

Background: We report a case of severe upper airway obstruction due to a retropharyngeal hematoma that presented nearly one day after a precipitating traumatic injury. Retropharyngeal hematomas are rare, but may cause life-threatening airway compromise.

Case presentation: A 50 year-old man developed severe dyspnea with oropharyngeal airway compression due to retropharyngeal hematoma 20 hours after presenting to the emergency department. The patient also had a fractured first cervical vertebra and was diagnosed with a left brachial plexopathy. The patient underwent emergent awake fiberoptic endotracheal intubation to provide a definitive airway.

Conclusion: Retropharyngeal hematoma with life-threatening airway compromise can develop hours or days after a precipitating injury. Clinicians should be alert to the potential for this delayed airway collapse, and should also be prepared to rapidly secure the airway in this patient population likely to have concomitant cervical spinal or head injuries.

No MeSH data available.


Related in: MedlinePlus

After surgical decompression, hematoma size is demonstrably reduced (arrow) in this sagittal MRI.
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Figure 5: After surgical decompression, hematoma size is demonstrably reduced (arrow) in this sagittal MRI.

Mentions: The following day the patient underwent surgical decompression. A moderate sized hematoma at the level of C4 was evacuated and a drain was placed for further decompression. A follow-up MRI was performed which revealed a bi-lobed disc herniation (determined to be chronic in nature) with secondary spinal canal encroachment and mass effect on the cervical spinal cord (Figures 4, 5). The retropharyngeal hematoma had resolved. The patient was successfully extubated with the use of a Cook exchange catheter on post-operative day one and discharged two days later.


Severe upper airway obstruction due to delayed retropharyngeal hematoma formation following blunt cervical trauma.

Lazott LW, Ponzo JA, Puana RB, Artz KS, Ciceri DP, Culp WC - BMC Anesthesiol (2007)

After surgical decompression, hematoma size is demonstrably reduced (arrow) in this sagittal MRI.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1828150&req=5

Figure 5: After surgical decompression, hematoma size is demonstrably reduced (arrow) in this sagittal MRI.
Mentions: The following day the patient underwent surgical decompression. A moderate sized hematoma at the level of C4 was evacuated and a drain was placed for further decompression. A follow-up MRI was performed which revealed a bi-lobed disc herniation (determined to be chronic in nature) with secondary spinal canal encroachment and mass effect on the cervical spinal cord (Figures 4, 5). The retropharyngeal hematoma had resolved. The patient was successfully extubated with the use of a Cook exchange catheter on post-operative day one and discharged two days later.

Bottom Line: The patient also had a fractured first cervical vertebra and was diagnosed with a left brachial plexopathy.Retropharyngeal hematoma with life-threatening airway compromise can develop hours or days after a precipitating injury.Clinicians should be alert to the potential for this delayed airway collapse, and should also be prepared to rapidly secure the airway in this patient population likely to have concomitant cervical spinal or head injuries.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anesthesiology, The Texas A&M University System Health Science Center College of Medicine, Scott & White Hospital, Temple, Texas, USA. llazott@swmail.sw.org

ABSTRACT

Background: We report a case of severe upper airway obstruction due to a retropharyngeal hematoma that presented nearly one day after a precipitating traumatic injury. Retropharyngeal hematomas are rare, but may cause life-threatening airway compromise.

Case presentation: A 50 year-old man developed severe dyspnea with oropharyngeal airway compression due to retropharyngeal hematoma 20 hours after presenting to the emergency department. The patient also had a fractured first cervical vertebra and was diagnosed with a left brachial plexopathy. The patient underwent emergent awake fiberoptic endotracheal intubation to provide a definitive airway.

Conclusion: Retropharyngeal hematoma with life-threatening airway compromise can develop hours or days after a precipitating injury. Clinicians should be alert to the potential for this delayed airway collapse, and should also be prepared to rapidly secure the airway in this patient population likely to have concomitant cervical spinal or head injuries.

No MeSH data available.


Related in: MedlinePlus