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

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.

Figure 1

Sagittal reconstruction from a CT scan upon patient arrival shows mild prominence of the prevertebral soft tissues, without clinically significant hematoma or encroachment on the airway (large white arrow).

Figure 2

Axial reconstruction from a CT scan upon patient arrival show mild prominence of the prevertebral soft tissues, without clinically significant hematoma or encroachment on the airway (large white arrow).

Figure 3

Sagittal T2 weighted MRI with fat saturation techniques revealing marked increase in the prevertebral soft tissue prominence secondary to an enlarging hematoma (large arrow). Note the severe compromise of the oropharyngeal airway (small arrow).

Figure 4

Axial T2 weighted MRI reveals a bi-lobed disc herniation (arrow), with secondary spinal canal encroachment and mass effect on the cervical spinal cord at the C6-7 level.

Figure 5

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