J Korean Soc Radiol.  2014 Feb;70(2):87-91. 10.3348/jksr.2014.70.2.87.

Spontaneous Retropharyngeal Hematoma: A Case Report and Literature Overview

• Ryu JH

• KMID: 1839417
• DOI: http://doi.org/10.3348/jksr.2014.70.2.87

Abstract

A spontaneous retropharyngeal hematoma is a rare condition with a difficult diagnostic. This disease may rapidly progress to an airway obstruction. The author reports about a case of a 56-year-old man with an acute onset of sore throat, dysphonia and dyspnea. A retropharyngeal high attenuated soft tissue density could be seen on the neck CT. A rapid improvement of the retropharyngeal abnormality was seen on the 3 days follow-up MR imaging. Signal changes caused by blood products which were visible on the MRI images suggested the diagnosis of retropharyngeal hematoma. The patient was conservatively managed.

MeSH Terms

Airway Obstruction
Diagnosis
Dysphonia
Dyspnea
Follow-Up Studies
Hematoma*
Humans
Magnetic Resonance Imaging
Middle Aged
Neck
Pharyngitis

Figure

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  Fig. 1 Plain neck lateral view shows markedly increased thickness of retropharyngeal prevertebral soft tissue.

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  Fig. 2 Precontrast (A) neck computed tomography scan show an expansile mass lesion with slightly high attenuation as compared with muscle (arrow). Postcontrast CT (B) shows the high attenuated lesion (arrow) with slight peripheral enhancement in retropharyngeal space with narrowing of airway from occiput to C7 level.

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  Fig. 3 Magnetic resonance imaging. Axial spin-echo T1-weighted image (A) shows heterogenously high signal intensity lesion (arrow) in retropharyngeal space. Gadolinium enhanced T1-weighted image (B) show non-enhancing retropharyngeal collection (arrow). The airway is moderately compromised. On axial T2-weighted image (C), the lesion (arrow) shows low signal intensity, suggestive of blood products such as subacute hematoma. Sagittal T2-weighted image (D) shows low signal intensity of retropharyngeal hematoma (arrow).

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  Fig. 4 On 3-days follow-up check of plain neck lateral view, retropharyngeal prevertebral soft tissue markedly decreased in thickness.

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