Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Surgical Treatment of a Life-Threatening Large Retropharyngeal Hematoma after Minor Trauma : Two Case Reports and a Literature Review

  • Park, Jin Hoon (Department of Neurological Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine) ;
  • Jeong, Eui-Kyun (Department of Anesthesiology, Gangneung Asan Hospital, University of Ulsan College of Medicine) ;
  • Kang, Dong-Ho (Department of Neurological Surgery, Gyeongsang National University School of Medicine) ;
  • Jeon, Sang Ryong (Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2014.10.02
  • Accepted : 2015.03.16
  • Published : 2015.10.28
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Abstract

Only a few cases of anterior longitudinal ligament (ALL) injury related with retropharyngeal hematoma without fracture have previously been reported. The treatment of choice for retropharyngeal hematoma is generally considered to be conservative care, but we believe that early surgery of this pathology would be better in certain situations. Here, we describe two cases with life-threatening large retropharyngeal hematomas related with ALL injuries and operated on at an early stage. Two previously healthy patients visited the emergency room with neck pain and dyspnea after falling. Serious neck swelling was observed and lateral neck X-ray showed severe widening of the prevertebral space. Due to dyspnea progression, emergency endotracheal intubation was performed. Although there was no primary cause of the retropharyngeal hematoma on preoperative examination, ALL tearing was intraoperatively confirmed during early surgery. The in-hospital evolutions of the patients were favorable after surgery. We should bear in mind the possibility of ALL injury and perform early surgery where possible given the earlier convalescence and good prognosis.

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References

  1. Akoglu E, Seyfeli E, Akoglu S, Karazincir S, Okuyucu S, Dagli AS : Retropharyngeal hematoma as a complication of anticoagulation therapy. Ear Nose Throat J 87 : 156-159, 2008
  2. Daniello NJ, Goldstein SI : Retropharyngeal hematoma secondary to minor blunt head and neck trauma. Ear Nose Throat J 73 : 41-43, 1994
  3. Duvillard C, Ballester M, Romanet P : Traumatic retropharyngeal hematoma : a rare and critical pathology needed for early diagnosis. Eur Arch Otorhinolaryngol 262 : 713-715, 2005 https://doi.org/10.1007/s00405-004-0767-3
  4. Hirshoren N, Gross M, Weinberger JM, Eliashar R : Retropharyngeal infected hematoma : a unique complication of nasogastric tube insertion. J Trauma 67 : 891, 2009 https://doi.org/10.1097/TA.0b013e31805d8f80
  5. Iizuka S, Morita S, Otsuka H, Yamagiwa T, Yamamoto R, Aoki H, et al. : Sudden asphyxia caused by retropharyngeal hematoma after blunt thyrocervical artery injury. J Emerg Med 43 : 451-456, 2012 https://doi.org/10.1016/j.jemermed.2011.05.094
  6. Jakanani G, Kenningham R, Bolia A : Active retropharyngeal hemorrhage from an acute thyrocervical artery injury : a rare complication of hyperextension cervical spine injury. J Emerg Med 43 : e39-e41, 2012 https://doi.org/10.1016/j.jemermed.2009.08.005
  7. Kelly CP, Haq N, Dove J : Life-threatening retropharyngeal haematoma. Injury 26 : 339-340, 1995 https://doi.org/10.1016/0020-1383(95)00011-W
  8. Lin JY, Wang CH, Huang TW : Traumatic retropharyngeal hematoma : case report. Auris Nasus Larynx 34 : 423-425, 2007 https://doi.org/10.1016/j.anl.2006.10.003
  9. Morita S, Iizuka S, Hirakawa H, Higami S, Yamagiwa T, Inokuchi S : A 92-year-old man with retropharyngeal hematoma caused by an injury of the anterior longitudinal ligament. Chin J Traumatol 13 : 120-122, 2010
  10. O'Donnell JJ, Birkinshaw R, Harte B : Mechanical airway obstruction secondary to retropharyngeal haematoma. Eur J Emerg Med 4 : 166-168, 1997 https://doi.org/10.1097/00063110-199709000-00010
  11. Ozyuvaci E, Akyol O, Erden DV, Vatansever SD, Yilmaz GD, Toprak N : Upper airway obstruction due to retropharyngeal haematoma after posterior cervical spine surgery. Anaesth Intensive Care 39 : 768-770, 2011
  12. Penning L : Prevertebral hematoma in cervical spine injury : incidence and etiologic significance. AJR Am J Roentgenol 136 : 553-561, 1981 https://doi.org/10.2214/ajr.136.3.553
  13. Pfeiffer J, Ridder GJ : An elderly woman with increasing dyspnoea after a fall. Emerg Med J 28 : 806-808, 2011 https://doi.org/10.1136/emj.12.2010.3642rep
  14. Senthuran S, Lim S, Gunning KE : Life-threatening airway obstruction caused by a retropharyngeal haematoma. Anaesthesia 54 : 674-678, 1999 https://doi.org/10.1046/j.1365-2044.1999.00890.x
  15. Silberstein M, Tress BM, Hennessy O : Prevertebral swelling in cervical spine injury : identification of ligament injury with magnetic resonance imaging. Clin Radiol 46 : 318-323, 1992 https://doi.org/10.1016/S0009-9260(05)80375-7
  16. Srivastava S, Solanki T : Retropharyngeal haematoma - an unusual bleeding site in an anticoagulated patient : a case report. Cases J 1 : 294, 2008 https://doi.org/10.1186/1757-1626-1-294
  17. Suzuki T, Imai H, Uchino M, Wakita R, Endo M, Kitahara T, et al. : Fatal retropharyngeal haematoma secondary to blunt trauma. Injury 35 : 1059-1063, 2004 https://doi.org/10.1016/j.injury.2003.11.013
  18. Takanami I, Abiko T, Koizumi S : Life-threatening airway obstruction due to retropharyngeal and cervicomediastinal hematomas following stellate ganglion block. Thorac Cardiovasc Surg 57 : 311-312, 2009 https://doi.org/10.1055/s-2008-1038845
  19. Tenofsky PL, Porter SW, Shaw JW : Fatal airway compromise due to retropharyngeal hematoma after airbag deployment. Am Surg 66 : 692-694, 2000
  20. Tsai SH, Hsu CW, Chu SJ : Traumatic retropharyngeal hematoma after a minor head injury. J Trauma 64 : 539, 2008 https://doi.org/10.1097/01.ta.0000224103.28021.53

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