J Korean Neurosurg Soc.  2015 Sep;58(3):304-307. 10.3340/jkns.2015.58.3.304.

Surgical Treatment of a Life-Threatening Large Retropharyngeal Hematoma after Minor Trauma : Two Case Reports and a Literature Review

• Park JH
• Jeong EK
• Kang DH
• Jeon SR

• KMID: 2191390
• DOI: http://doi.org/10.3340/jkns.2015.58.3.304

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.

Keyword

Longitudinal ligaments; Hematoma; Airway obstruction; Spine; Intubation; Surgeons

MeSH Terms

Airway Obstruction
Convalescence
Dyspnea
Emergencies
Emergency Service, Hospital
Hematoma*
Humans
Intubation
Intubation, Intratracheal
Longitudinal Ligaments
Neck
Neck Pain
Pathology
Prognosis
Spine
Tears

Figure

• 

  Fig. 1 A : A lateral X-ray image of a 51-year-old male patient showing widening of the prevertebral space. B : T2-weighted sagittal MRI of the same patient. MRI shows a longitudinal mass with heterogeneous signal intensity in the retropharyngeal space from the C3 to T2 levels and high signal intensity at the C4 and C5 bodies. C : T1-weighted sagittal MRI of the same patient shows a mass with low signal intensity in the retropharyngeal space and slightly higher signal intensity at the lower C4 and C5 bodies, although there was low signal intensity at the upper C4 body.

• 

  Fig. 2 Lateral X-ray images after surgery. A gradual decrease in the widening of the prevertebral space is seen. At the fifth postoperative day, extubation was possible.

• 

  Fig. 3 A : A lateral X-ray image of a 78-year-old male patient showing widening of the prevertebral space. B : CT angiography showed prevertebral hematoma and a dark air density region at the C6-7 disc.

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