Retropharyngeal Hematoma as an Unusual Presentation of Myelodysplastic Syndrome: A Case Report

Abstract

BACKGROUND Retropharyngeal hematoma is a relatively rare diagnosis that requires a high clinical suspicion and stabilization of the airway to prevent rapid deterioration. We report a case of a spontaneous retropharyngeal hematoma in an elderly patient with myelodysplastic syndrome and associated thrombocytopenia. CASE REPORT A 90-year-old man with myelodysplastic syndrome was brought to the Emergency Department with complaints of difficulty swallowing and muffled voice for 24 hours. Upon arrival, his vital signs and physical exam were unremarkable, except that when he was asked to take a sip of water, he could not swallow it. Complete blood count was remarkable for leukocytosis of 14.3×10³/mcL, hemoglobin of 9.0 gm/dL, and platelet count of 26×10³/mcL. Chest X-ray and lateral soft-tissue neck X-rays were grossly unremarkable. The patient was admitted for further evaluation and was scheduled for esophagogastroduodenoscopy. During intubation for esophagogastroduodenoscopy, the patient was noted to have significant airway narrowing. A subsequent CT scan revealed a 3×2×2 cm supraglottic hypodensity, thought to represent a retropharyngeal hematoma. The patient was transferred to the Intensive Care Unit (ICU) and received platelet transfusions. The ICU course was complicated by anemia, which necessitated transfusion of packed red blood cells. On hospital day 7, the patient reported resolution of his symptoms and was discharged home. CONCLUSIONS This case adds to the growing body of literature on spontaneous retropharyngeal hematomas. High clinical suspicion is warranted in patients who present with acute dysphagia, odynophagia, and dysphonia. Prompt imaging and airway management are vital in managing patients with this condition.

Figure 1.

A lateral soft-tissue X-ray of the neck was obtained after initial chest X-ray was negative. The lateral film was read as equivocal, with possible thickening of the arylepiglottic folds (arrow).

Figure 2.

Sagittal CT obtained after abnormal findings noted on direct laryngoscopy showed a 3×2×2 cm supraglottic hypodensity (arrow), thought to represent a spontaneous retropharyngeal hematoma.