DELAYED AIRWAY STENOSIS CAUSED BY TRAUMATIC RETROPHARYNGEAL HEMATOMA : A CASE REPORT
Background : Retropharyngeal hematoma (RPH) is a low-frequency injury that accounts for approximately 1% of all blunt trauma cases and can cause airway narrowing. Case : A 79-year-old woman was admitted to our emergency department with trauma following a traffic accident, and was diagnosed with RPH...
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| Published in | Journal of the Japanese Association for the Surgery of Trauma Vol. 39; no. 1; pp. 1 - 5 |
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| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
The Japanese Association for the Surgery of Trauma
20.01.2025
一般社団法人 日本外傷学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1340-6264 2188-0190 |
| DOI | 10.11382/jjast.39.1_01 |
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| Abstract | Background : Retropharyngeal hematoma (RPH) is a low-frequency injury that accounts for approximately 1% of all blunt trauma cases and can cause airway narrowing. Case : A 79-year-old woman was admitted to our emergency department with trauma following a traffic accident, and was diagnosed with RPH by computed tomography, revealing that the anteroposterior diameter of the posterior pharyngeal wall gap was C2 12 mm and C6 11.7 mm. Respiratory and circulatory control were well-maintained at the time of admission, but airway stenosis occurred 5 h after admission. Oral intubation was difficult, so cricothyrotomy was performed, with tracheostomy the following day. Airway stenosis improved after the disappearance of the hematoma. The tracheal tube was removed on the 42nd day, and the patient was discharged. Discussion : RPH can cause delayed airway narrowing, so close observation and appropriate airway management are important. |
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| AbstractList | Background : Retropharyngeal hematoma (RPH) is a low-frequency injury that accounts for approximately 1% of all blunt trauma cases and can cause airway narrowing. Case : A 79-year-old woman was admitted to our emergency department with trauma following a traffic accident, and was diagnosed with RPH by computed tomography, revealing that the anteroposterior diameter of the posterior pharyngeal wall gap was C2 12 mm and C6 11.7 mm. Respiratory and circulatory control were well-maintained at the time of admission, but airway stenosis occurred 5 h after admission. Oral intubation was difficult, so cricothyrotomy was performed, with tracheostomy the following day. Airway stenosis improved after the disappearance of the hematoma. The tracheal tube was removed on the 42nd day, and the patient was discharged. Discussion : RPH can cause delayed airway narrowing, so close observation and appropriate airway management are important. Background : Retropharyngeal hematoma (RPH) is a low-frequency injury that accounts for approximately 1% of all blunt trauma cases and can cause airway narrowing. Case : A 79-year-old woman was admitted to our emergency department with trauma following a traffic accident, and was diagnosed with RPH by computed tomography, revealing that the anteroposterior diameter of the posterior pharyngeal wall gap was C2 12 mm and C6 11.7 mm. Respiratory and circulatory control were well-maintained at the time of admission, but airway stenosis occurred 5 h after admission. Oral intubation was difficult, so cricothyrotomy was performed, with tracheostomy the following day. Airway stenosis improved after the disappearance of the hematoma. The tracheal tube was removed on the 42nd day, and the patient was discharged. Discussion : RPH can cause delayed airway narrowing, so close observation and appropriate airway management are important. 【背景】咽頭後間隙血腫 (Retropharyngeal Hematoma : RPH) は鈍的外傷のうち約1%と低頻度であるが, 気道狭窄を来すことがある. 【症例】79歳, 女性. 交通外傷で救急搬送となる. CTを施行したところ, 咽頭後間隙前後径 (以下, 前後径) はC2 12mm, C6 11.7mm でありRPHと診断した. 来院時の呼吸・循環動態は保たれていたが, 来院5時間後に気道狭窄を来した. 経口気管挿管は困難であり, 輪状甲状靱帯間膜切開を行い, 翌日気管切開術を施行した. 血腫の消退とともに気道狭窄は改善し, 入院42日目に気管切開チューブを抜去, 自宅退院となった. 【考察】RPHは遅発的に気道狭窄を起こす可能性があり, 厳重な経過観察と適切な気道管理が重要となる. |
| Author | NAGAMINE, Yoshiyuki YOKOBORI, Shoji KOBAYASHI, Tatsuho YAMAMURA, Eiji NAMATAME, Kaoru |
| Author_FL | 山村 英治 KOBAYASHI Tatsuho 横堀 將司 生天目 かおる NAGAMINE Yoshiyuki |
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| DocumentTitleAlternate | 外傷性咽頭後間隙血腫による遅発性気道狭窄を来した症例 : 症例報告 |
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| References | 11) Park JH, Jeong EK, Kang DH, et al : Surgical Treatment of a Life-Threatening Large Retropharyngeal Hematoma after Minor Trauma : Two Case Reports and a Literature Review. J Korean Neurosurg Soc 2015 ; 58 : 304-307. 3) Sugiura G, Takahashi H, Kodama Y, et al : Successful management of retropharyngeal hematoma by trans-arterial embolism without intubation. Int J Emerg Med 2021 ; 14 : 3. 10) Iizuka S, Morita S, Otsuka H, et al : Sudden asphyxia caused by retropharyngeal hematoma after blunt thyrocervical artery injury. J Emerg Med 2012 ; 43 : 451-456. 14) Baek JH, Kim JH : Retropharyngeal hematoma secondary to cervical hyperextension in a minor collision trauma presenting with dyspnoea : A case report. Medicine (Baltimore) 2020 ; 99 : e21528. 7) 藤原良平, 寺尾恭一, 森川大樹, ほか : 咽頭後間隙血腫の2例. 頭頸部外 2014 ; 24 : 161-167. 13) 宮崎敬太, 村上公子, 谷口徹, ほか : 軽微な外傷により発症した高齢者の咽頭後間隙血腫の1例. 日外傷会誌 2022 ; 36 : 1-4. 5) McLauchlan CA, Pidsley R, Vandenberk PJ : Minor trauma--major problem. Neck injuries, retropharyngeal haematoma and emergency airway management. Arch Emerg Med 1991 ; 8 : 135-139. 9) Anagnostara A, Athanassopoulou A, Kailidou E, et al : Traumatic retropharyngeal hematoma and prevertebral edema induced by whiplash injury. Emerg Radiol 2005 ; 11 : 145-149. 6) Kette F, Mergoni P, Girardis M, et al : Delayed upper airway obstruction following a retropharyngeal haematoma after minor head trauma. Eur J Emerg Med 2000 ; 7 : 301-303. 2) Kuhn JE, Graziano GP : Airway compromise as a result of retropharyngeal hematoma following cervical spine injury. J Spinal Disord 1991 ; 4 : 264-269. 12) Tsao YL, Hsu CC, Chen KT : Blunt Traumatic Retropharyngeal Hematoma with Respiratory Symptoms : A Systematic Review of Reported Cases. Emerg Med Int 2021 ; 2021 : 5158403. 8) 田中真生, 米満尚史, 川副友, ほか : 頭頚部外傷後の咽頭後間隙血腫により上気道狭窄を来した2例. 日救急医会誌 2014 ; 25 : 119-124. 1) Kudo S, Fukushima K, Hashimoto M, et al : Airway and circulatory collapse due to retropharyngeal hematoma after blunt vertebral artery injury. Am J Emerg Med 2017 ; 35 : 806.e5-e7. 4) Jakanani G, Kenningham R, Bolia A : Active retropharyngeal hemorrhage from an acute thyrocervical artery injury : a rare complication of hyperextension cervical spine injury. J Emerg Med 2012 ; 43 : e39-41. |
| References_xml | – reference: 10) Iizuka S, Morita S, Otsuka H, et al : Sudden asphyxia caused by retropharyngeal hematoma after blunt thyrocervical artery injury. J Emerg Med 2012 ; 43 : 451-456. – reference: 6) Kette F, Mergoni P, Girardis M, et al : Delayed upper airway obstruction following a retropharyngeal haematoma after minor head trauma. Eur J Emerg Med 2000 ; 7 : 301-303. – reference: 11) Park JH, Jeong EK, Kang DH, et al : Surgical Treatment of a Life-Threatening Large Retropharyngeal Hematoma after Minor Trauma : Two Case Reports and a Literature Review. J Korean Neurosurg Soc 2015 ; 58 : 304-307. – reference: 2) Kuhn JE, Graziano GP : Airway compromise as a result of retropharyngeal hematoma following cervical spine injury. J Spinal Disord 1991 ; 4 : 264-269. – reference: 5) McLauchlan CA, Pidsley R, Vandenberk PJ : Minor trauma--major problem. Neck injuries, retropharyngeal haematoma and emergency airway management. Arch Emerg Med 1991 ; 8 : 135-139. – reference: 1) Kudo S, Fukushima K, Hashimoto M, et al : Airway and circulatory collapse due to retropharyngeal hematoma after blunt vertebral artery injury. Am J Emerg Med 2017 ; 35 : 806.e5-e7. – reference: 8) 田中真生, 米満尚史, 川副友, ほか : 頭頚部外傷後の咽頭後間隙血腫により上気道狭窄を来した2例. 日救急医会誌 2014 ; 25 : 119-124. – reference: 12) Tsao YL, Hsu CC, Chen KT : Blunt Traumatic Retropharyngeal Hematoma with Respiratory Symptoms : A Systematic Review of Reported Cases. Emerg Med Int 2021 ; 2021 : 5158403. – reference: 7) 藤原良平, 寺尾恭一, 森川大樹, ほか : 咽頭後間隙血腫の2例. 頭頸部外 2014 ; 24 : 161-167. – reference: 13) 宮崎敬太, 村上公子, 谷口徹, ほか : 軽微な外傷により発症した高齢者の咽頭後間隙血腫の1例. 日外傷会誌 2022 ; 36 : 1-4. – reference: 9) Anagnostara A, Athanassopoulou A, Kailidou E, et al : Traumatic retropharyngeal hematoma and prevertebral edema induced by whiplash injury. Emerg Radiol 2005 ; 11 : 145-149. – reference: 3) Sugiura G, Takahashi H, Kodama Y, et al : Successful management of retropharyngeal hematoma by trans-arterial embolism without intubation. Int J Emerg Med 2021 ; 14 : 3. – reference: 14) Baek JH, Kim JH : Retropharyngeal hematoma secondary to cervical hyperextension in a minor collision trauma presenting with dyspnoea : A case report. Medicine (Baltimore) 2020 ; 99 : e21528. – reference: 4) Jakanani G, Kenningham R, Bolia A : Active retropharyngeal hemorrhage from an acute thyrocervical artery injury : a rare complication of hyperextension cervical spine injury. J Emerg Med 2012 ; 43 : e39-41. |
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| SubjectTerms | airway emergencies tracheal intubation traumatic retropharyngeal hematoma 外傷性咽頭後間隙血腫 気管挿管 気道緊急 |
| Title | DELAYED AIRWAY STENOSIS CAUSED BY TRAUMATIC RETROPHARYNGEAL HEMATOMA : A CASE REPORT |
| URI | https://www.jstage.jst.go.jp/article/jjast/39/1/39_39.1_01/_article/-char/en https://cir.nii.ac.jp/crid/1390302934382013824 |
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