Inokuchi Go, Kurita Nobuhiko, Baba Miyuki, Hata Yuko, Okuno Taeko
Department of Otorhinolaryngology, Mitsui Memorial Hospital, Tokyo, Japan.
Auris Nasus Larynx. 2012 Oct;39(5):527-30. doi: 10.1016/j.anl.2011.09.002. Epub 2011 Nov 6.
A case of a spontaneous retropharyngeal hematoma in a patient on chronic hemodialysis is described. A 75-year-old man presented with a 5-day history of throat discomfort and neck swelling. He had been on hemodialysis for chronic renal failure with secondary hyperparathyroidism. Examination showed a massively enlarged neck and bruising on his left neck and anterior chest. Flexible nasopharyngoscopy revealed bluish bulging of the posterior pharyngeal wall, and CT showed widening of prevertebral soft tissue. Hemodialysis reduced the swelling of the posterior pharyngeal wall, and conservative management including steroids and antibiotics was adequate for managing the airway and hematoma. Retropharyngeal swelling of this patient seemed to be derived not only from the hematoma itself, but also from the lymphatic and venous congestion. Follow-up CT and MRI indicated that the enlarged left parathyroid was the bleeding source. To the best of our knowledge, this is the second report of a retropharyngeal hematoma from parathyroid hyperplasia in a chronic hemodialysis patient. Physicians should be aware that rare parathyroid hemorrhage in chronic hemodialysis patients could lead to airway obstruction by retropharyngeal swelling.
本文描述了一例慢性血液透析患者自发性咽后血肿的病例。一名75岁男性，有5天的咽喉不适和颈部肿胀病史。他因慢性肾衰竭合并继发性甲状旁腺功能亢进接受血液透析治疗。检查发现颈部明显肿大，左侧颈部和前胸有瘀斑。纤维鼻咽喉镜检查显示咽后壁呈蓝色隆起，CT显示椎前软组织增宽。血液透析减轻了咽后壁的肿胀，包括使用类固醇和抗生素在内的保守治疗足以管理气道和血肿。该患者的咽后肿胀似乎不仅源于血肿本身，还源于淋巴和静脉充血。随访CT和MRI显示左侧甲状旁腺肿大是出血来源。据我们所知，这是第二例关于慢性血液透析患者甲状旁腺增生导致咽后血肿的报告。医生应意识到，慢性血液透析患者罕见的甲状旁腺出血可能导致咽后肿胀引起气道阻塞。
