Posterior mediastinal hematoma after a simple fall in a patient with normal coagulation

Abstract

Case: A 77-year-old woman presented with neck swelling and odynophagia following a fall from standing height. She had no history of antiplatelet or anticoagulant use. Computed tomography of the chest showed an isodense to hypodense soft tissue mass in the bilateral carotid space, retropharyngeal space, and posterior mediastinum. With no airway obstruction symptoms, the patient was placed on bed rest under close observation.

Outcome: The mass decreased in size spontaneously over the 10 days following symptom onset, accompanied by overall clinical improvement. The patient was diagnosed with a posterior mediastinal hematoma.

Conclusion: This is the first reported case of posterior mediastinal hematoma caused by a neck hyperextension injury secondary to a simple fall in a patient with normal coagulation. The outcome was good; however, emergency physicians should be aware that hematomas necessitating airway management may occur after a fall.

Keywords: Accidental fall; cervical injury; elderly; hematoma; mediastinum.

Figure 1

Contrast‐enhanced computed tomography scan of a 77‐year‐old woman with neck swelling and odynophagia following a fall from standing height. The scan shows a retropharyngeal/posterior mediastinal hematoma (white arrows), taken at the local hospital on the day of injury (A, sagittal; B, axial; aortic arch level).

Figure 2

(A) Contrast‐enhanced computed tomography scan of a 77‐year‐old woman with neck swelling and odynophagia following a fall from standing height, carried out at our hospital on day 2 after the injury. (B) Follow‐up non‐contrast computed tomography scan on day 18. On both images, the hematoma (white arrows) is reduced in size from the day of injury.

Figure 3

Bronchoscopy (A) and endobronchial ultrasound (B) carried out on the ninth day of hospitalization of a 77‐year‐old woman with neck swelling and odynophagia following a fall from standing height. White arrows indicate submucosal hemorrhage of the airway wall (A) and the abnormal heterogeneous echo area suspected of hosting the hematoma (B).