後咽頭間隙血腫による遅発性上気道閉塞

Abstract

Mechanical upper airway obstruction following a retropharyngeal hematoma is a life-threatening. We present a rare case of upper airway obstruction from a retropharyngeal hematoma in a patient with minor head and neck injuries. An 82-year-old man who had fallen from the roof of his house was transferred to the emergency department of our facility. He had a minor head injury, but retained consciousness. A computed tomographic (CT) scan and radiographs of his head and neck revealed no fracture. Six hours later, the patient complained of dyspnea and was again transferred to the emergency department. Extensive cervical swelling was noted. Emergency orotracheal intubation was performed for his severe stridor, cyanosis and dyspnea. CT scan and MRI revealed that a massive hematoma had developed in the retropharyngeal space. A few days later, the endotracheal tube was extubated; however, he again complained of difficulty in breathing, and swelling of his retropharynx made reintubation difficult. The patient underwent tracheostomy after reintubation using bronchoscopy. The retropharyngeal hematoma spontaneously resolved in about 4 weeks, after which the patient was discharged in good condition. In trauma patients with upper airway obstruction, we should include examination for retropharyngeal hematoma. The importance of airway assessment in a patient with even minor head and neck injuries should be seriously considered.