外傷性咽頭後間隙血腫例

Abstract

Retropharyngeal hematoma is an uncommonly encountered condition. However, early diagnosis and appropriate treatment are important owing to the risk of upper airway obstruction. We report a case of retropharyngeal hematoma that needed surgical drainage. A 73-year-old man receiving anticoagulant therapy sustained injury when he fell to the ground on his face. Cervical CT and MRI showed a retropharyngeal hematoma extending from the retropharyngeal to the superior mediastinal space. Flexible fiberoptic laryngoscopy revealed no airway obstruction. However, on day 10 after the injury, the hematoma was found to have increased in size; although there was no dyspnea at the time, owing to the imminent risk of airway obstruction, we performed surgical drainage of the hematoma with no tracheostomy. We reviewed 43 articles on retropharyngeal hematoma reported in the literature to elucidate the clinical characteristics, treatment, and outcomes of this condition. More than a half of the cases published in these reports received conservative treatment; however, about 30% of the cases eventually required tracheostomy because of airway obstruction.