Active Retropharyngeal Hemorrhage from an Acute Thyrocervical Artery Injury: A Rare Complication of Hyperextension Cervical Spine Injury

Abstract

Background: Acute vascular injury is uncommon after cervical spine injury. We describe a recent case of active retropharyngeal bleeding from the thyrocervical artery after an acute cervical spine injury. Objectives: The case illustrates an unusual vascular injury diagnosed by 64-slice multidetector computed tomography (MDCT) and managed successfully by emergency transcatheter embolization. Case Report: A 65-year-old woman presented to the Emergency Department after a fall. MDCT scans of the cervical spine revealed a fracture of C5 and a large prevertebral hematoma. Subsequent MDCT carotid angiography revealed active bleeding from a branch of the right thyrocervical trunk. Superselective catheterization into the right thyrocervical trunk confirmed this as the source vessel. A 3-mm coil was deployed without complication. Conclusion: This case illustrates an unusual arterial injury in the context of cervical spine trauma and how, as endovascular services become more accessible out of hours, the management of patients with acute arterial injury is increasingly a multidisciplinary team effort. Early recognition by the emergency physician of potential vascular injury and prompt referral for appropriate imaging will expedite treatment and improve clinical outcome.