Gaku Sugiura1, Hiroyuki Takahashi2, Yoshihisa Kodama3, Satoshi Nara2. 1. Emergency and Critical Care Medical Center, Teine Keijinkai Hospital, 1-jo 12-chome 1-40, Maeda, Teine-ku, Sapporo, 006-8555, Japan. gakusugiura@gmail.com. 2. Emergency and Critical Care Medical Center, Teine Keijinkai Hospital, 1-jo 12-chome 1-40, Maeda, Teine-ku, Sapporo, 006-8555, Japan. 3. Department of Radiology, Teine Keijinkai Hospital, Sapporo, Japan.
Abstract
BACKGROUND: Retropharyngeal hematoma can cause suffocation if there is delay in securing the airway by intubation. However, there are also concerns about complications that can arise with intubation; it is still unknown which cases do not require intubation. CASE PRESENTATION: An 88-year-old woman slipped and was found prone and was transported to the emergency room. She was alert without any stridor. Physical examination revealed a subcutaneous hematoma in the anterior cervical region. Computed tomography revealed a retropharyngeal hematoma. Angiography and computed tomography angiography showed extravasation from the right costocervical trunk. A radiologist performed trans-arterial embolization, and she had an uneventful course without intubation or developing any complication. She became ambulatory on postoperative day 5. CONCLUSION: Angiography and computed tomography angiography help in early recognition of extravasation in retropharyngeal hematoma, and trans-arterial embolization can help to avoid intubation and its complications.
BACKGROUND: Retropharyngeal hematoma can cause suffocation if there is delay in securing the airway by intubation. However, there are also concerns about complications that can arise with intubation; it is still unknown which cases do not require intubation. CASE PRESENTATION: An 88-year-old woman slipped and was found prone and was transported to the emergency room. She was alert without any stridor. Physical examination revealed a subcutaneous hematoma in the anterior cervical region. Computed tomography revealed a retropharyngeal hematoma. Angiography and computed tomography angiography showed extravasation from the right costocervical trunk. A radiologist performed trans-arterial embolization, and she had an uneventful course without intubation or developing any complication. She became ambulatory on postoperative day 5. CONCLUSION: Angiography and computed tomography angiography help in early recognition of extravasation in retropharyngeal hematoma, and trans-arterial embolization can help to avoid intubation and its complications.
Authors: Paras Karmacharya; Ranjan Pathak; Sailu Ghimire; Pragya Shrestha; Sushil Ghimire; Dilli Ram Poudel; Raju Khanal; Shirin Shah; Madan Raj Aryal; Richard L Alweis Journal: N Am J Med Sci Date: 2015-11