Rapidly progressive complete airway obstruction by acute retropharyngeal hematoma

Abstract

Background: Although Retropharyngeal Hematoma (RPH) has unknown frequency but considered a rare condition which can cause a life threatening airway obstruction. Various precipitating factors have been mentioned as causes of RPH as blunt head or neck trauma, whiplash injury, coagulopathy, central line insertion, stellate ganglion block, sneezing, severe coughing as well as spontaneous RPH. Methods: We report a case of severe life threatening retropharyngeal hematoma secondary to a closed stable C5-C6 fracture that caused severe upper airway obstruction. Results: As the RPH can develop hours or days, even after an apparently minor precipitating injury, in our patient it took almost 3 hours from time of accident till the development of severe upper airway obstruction (picture to be added in main poster). It was such a large collection hematoma that caused severe upper airway obstruction with cannot intubate cannot intubate situation. Conclusion: RPH can cause a mechanical displacement of the pharynx & larynx making securing airway with ETT almost impossible with conventional laryngoscopy or even video-assisted techniques. On the other hand, the time taken for RPH to develop and to cause mechanical obstruction can be limited enough to allow proper preparations as well as availability of fiberoptic technique. We should keep a high index of suspicion of retropharyngeal hematoma and airway involvement in cases of cervical spine fracture, in order to help other physician to increase their awareness and anticipation of such life threatening & meantime avoidable condition. Keywords: retropharyngeal hematoma, airway obstruction