Spontaneous cervical hemorrhage with near-complete airway obstruction

Background. Retropharyngeal hematoma is a rare entity which may progress rapidly to airway obstruction. Previously documented causes have included coagulopathic states, trauma, infection, parathyroid adenoma rupture, and foreign-object ingestion. Four cases of spontaneous retropharyngeal hematomas without any known predisposing risk factors have been previously reported. Two of these cases had fatal outcomes. Methods. A case report is presented and the literature reviewed. Results. Spontaneous cervical hematoma with parapharyngeal and retropharyngeal involvement which caused near-complete respiratory obstruction occurred in an otherwise healthy young man following straining. Initial management involved fiberoptic nasotracheal intubation. Subsequent right neck exploration revealed hemorrhage from a branch of the external carotid artery, which was ligated. An arteriogram revealed minimal flow through the right external carotid artery and its branches. The patient was extubated and discharged uneventfully on the fourth postoperative day. Conclusion. The possible etiology for this case is discussed, and a review of the literature and the role of surgery in the management of this entity is outlined. (C) 1998 John Wiley & Sons, Inc.