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. 2023 Aug;7(3):168-171.
doi: 10.5811/cpcem.1602.

Retropharyngeal Hematoma Causing Airway Compromise After Tissue Plasminogen Activator Administration: A Case Report

Christian Provenza  1 , Arun Christian Habermann  2 , Theron Williams  1 , Jeffrey Metter  3 , James Richard Walker 3rd  1
Affiliations

Retropharyngeal Hematoma Causing Airway Compromise After Tissue Plasminogen Activator Administration: A Case Report

Christian Provenza et al. Clin Pract Cases Emerg Med. 2023 Aug.

Abstract

Introduction: Tissue plasminogen activator (tPA), commonly used for treatment of acute ischemic stroke, is associated with life-threatening bleeding intracranially as well as surrounding the airway.

Case report: A 78-year-old year old male who presented with stroke symptoms and after tPA administration developed a retropharyngeal hematoma requiring intubation and surgical intervention.

Conclusion: Numerous threats to the patient's airway can develop after tPA administration. While angioedema is the most common cause, it is important to be prepared for other causes related to hemorrhage.

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Conflict of interest statement

Conflicts of Interest: By the CPC-EM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.

Figures

Image 1
Image 1
Sagittal slice of the computed tomography of the patient’s cervical spine prior to administration of tissue plasminogen activator. The arrow identifies the level of the patient’s anterior longitudinal ligament rupture and source of his future bleeding.
Image 2
Image 2
Bilateral sixth cervical vertebra pedicle fractures (arrows) on arrival (left) and post-intubation (right). This image shows the initial subtle fractures that appear similar to vascular channels compared to the clear fractures after intubation.
Image 3
Image 3
Sagittal slice of magnetic resonance imaging of the patient’s retropharyngeal hematoma, demonstrating total occlusion of the airway at the midline. The endotracheal tube can be visualized above and below the hematoma at this slice. The arrow identifies the ruptured anterior longitudinal ligament and source of the patient’s hematoma. The cervical 5–6 disc space is noticeably wider when compared to cmputed tomography imaging obtained before administration of tissue plasminogen activator (Image 1).
See this image and copyright information in PMC

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