Abstract
Nontraumatic haematoma of parapharyngeal space is very rare and may cause dysphagia and dyspnea. The authors present a case report of a 74-year-old woman with sudden nontraumatic neck swelling without dyspnea and with left pharyngeal bulging and endolaryngeal displacement. Parathyroid hormone elevation and imaging exams confirmed bleeding from a parathyroid adenoma. Symptoms and signs resolved after one week of conservative treatment. There are few cases of parapharyngeal haematomas caused by parathyroid adenomas. Most patients can be managed without emergent surgery, but close airway monitoring is fundamental.
Highlights
A 74-year-old woman presented to the emergency department with sudden onset (24 hours) of painful neck swelling and concurrent dysphonia and solid dysphagia
Nasofiberoscopy showed bulging of the left lateral pharyngeal wall leading to right displacement of the endolarynx
Discussion is is a very rare clinical situation: until 2009, only 28 cases of spontaneous cervical haematoma caused by extracapsular rupture of the parathyroid gland were reported [4]
Summary
Lesions of parapharyngeal space are rare, comprising only 0.5% of head and neck neoplasms [1]. ey may cause dysphagia and dyspnea by compression of upper aerodigestive tract. A 74-year-old woman presented to the emergency department with sudden onset (24 hours) of painful neck swelling and concurrent dysphonia and solid dysphagia. Computed tomography revealed a nonenhancing collection in the left parapharyngeal space (Figure 1). Magnetic resonance imaging confirmed the presence of a parapharyngeal haematoma with probable origin in a parathyroid adenoma (Figure 2). There was complete symptom resolution and fiberoscopy showed neither pharyngeal bulging nor endolaryngeal displacement (Figure 3). 3. Discussion is is a very rare clinical situation: until 2009, only 28 cases of spontaneous cervical haematoma caused by extracapsular rupture of the parathyroid gland were reported [4]. Expansion and bleeding outside the capsule may be due to the fact that parathyroid glands containing tumors have relatively thin and weak capsules [5]. e thyroid and the parathryoid glands are wrapped in a part of the pretracheal fascia, which is deficient on the posterior aspect of the isthmus and most of the posteromedial surface of the lobe
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