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Images in emergency medicine
A woman with sudden-onset facial oedema
  1. Takashi Fujiwara1,
  2. Akira Kuriyama2,
  3. Taro Shimizu3
  1. 1Department of Otolaryngology Head and Neck Surgery, Ehime University, Ehime, Japan
  2. 2Department of General Medicine, Kurashiki Central Hospital, Okayama, Japan
  3. 3Department of General Internal Medicine, Hikarigaoka Hospital, Tokyo, Japan
  1. Correspondence to Takashi Fujiwara, Department of Otolaryngology Head and Neck Surgery, Ehime University School of Medicine, ShitsukawaToon City, Ehime 791-0295, Japan; t.fujiwarabi{at}gmail.com

https://doi.org/10.1136/emermed-2012-202314

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    An 84-year-old woman presented with acute facial oedema that developed suddenly 2 h prior to the visit. She had no particular medical history, no episode of neck injury, nor was she on any anticoagulant or antiplatelet agent. CT showed a pharyngeal mass (figure 1), which was confirmed as a retropharyngeal haematoma with a nasopharyngeal fiberscope (figure 2). A clinical diagnosis of spontaneous retropharyngeal haematoma was established.

    Figure 2
    Figure 2

    Clinical diagnosis of spontaneous retropharyngeal haematoma.

    Retropharyngeal haematoma is a rare but potentially life-threatening condition; it can progress rapidly, causing airway obstruction once it starts to grow.1 It has been reported to develop in patients who have suffered blunt head or neck trauma or who are on anticoagulants or antiplatelet agents, and spontaneous cases are rare.

    Airway management is crucial; prophylactic intubation or tracheostomy is sometimes considered. For this patient, given that the retropharyngeal haematoma was too small to perform tracheal intubation even when it enlarged, we followed the haematoma with a nasopharyngeal fiberscope every 30 min after diagnosis. No growth of the haematoma was confirmed after the first examination. The haematoma started to resolve on the third day, and the facial oedema disappeared accordingly, resulting in complete recovery.

    Reference

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      1. Bloom DC,
      2. Haegen T,
      3. Keefe MA
      . Anticoagulation and spontaneous retropharyngeal hematoma. J Emerg Med 2003;24:389–94.
      OpenUrlCrossRefPubMed

    Footnotes

    • Contributors TF and AK looked after the patient, and wrote the draft. All authors approved the submission of the current manuscript.

    • Competing interests None.

    • Patient consent Obtained.

    • Ethics approval Kurashiki Central Hospital.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Open Access This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/