Clinical communication
Spontaneous retropharyngeal hematoma: An unusual presentation of thoracic aortic dissection

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Abstract

A 78-year-old woman presented to the Emergency Department with spontaneous ecchymosis and swelling of the neck. Ecchymosis was also evident on the posterior pharyngeal wall. A lateral soft tissue radiograph demonstrated a retropharyngeal hematoma, which was confirmed by computed tomography (CT). At this time there was no evidence of airway obstruction and she was admitted for observation. One week after admission she became acutely short of breath, and a chest radiograph at this time showed a large pleural effusion. Pleural drainage confirmed this to be a hemothorax. Subsequent CT revealed a thoracic aortic dissection with blood communicating into both the retropharyngeal space and the pleural cavity. The case highlights both an unusual presentation of thoracic aortic dissection, and also the potential for occult hemorrhage in cases of spontaneous retropharyngeal hematoma.

Introduction

Retropharyngeal hematoma is an uncommon occurrence, but may cause rapid, life-threatening airway obstruction (1, 2). This report describes a case of spontaneous retropharyngeal hematoma due to hemorrhage from a thoracic aortic dissection, and illustrates the potential serious consequence of massive blood loss. This case also highlights an unusual presentation of thoracic aortic dissection. The institutional review board waived review of this case.

Section snippets

Clinical Data

A 78-year-old woman presented to the Emergency Department (ED) with a 2-day history of swelling and ecchymosis of the neck. There had been no head or neck trauma. She had noticed hoarseness of her voice for 2 weeks but reported no problems with swallowing or breathing. Her previous medical history included hypothyroidism, treated with thyroxine, and asthma, controlled by inhaled beclomethasone and oral theophylline. She had no known bleeding disorders and there had been no recent use of oral

Discussion

The retropharyngeal space is a potential space with complex anatomy. It extends from the base of the skull to the posterior mediastinum and therefore provides a communication between the neck and chest. It also connects with other parapharyngeal spaces, hence, bleeding into this space can be seen subcutaneously on the anterior neck.

Retropharyngeal hemorrhage is an uncommon occurrence but can have serious consequences. If the hematoma is contained locally it can cause airway obstruction due to

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