Thamamongood Thiparpa Aime, Onuki Takuya, Kuramochi Masami, Inagaki Masaharu
Department of Neurosurgery Tokyo Medical and Dental University Tokyo Japan.
Department of General Thoracic Surgery Tsuchiura Kyodo General Hospital Ibaraki Japan.
Acute Med Surg. 2015 May 12;3(1):43-45. doi: 10.1002/ams2.119. eCollection 2016 Jan.
A 77-year-old woman presented with neck swelling and odynophagia following a fall from standing height. She had no history of antiplatelet or anticoagulant use. Computed tomography of the chest showed an isodense to hypodense soft tissue mass in the bilateral carotid space, retropharyngeal space, and posterior mediastinum. With no airway obstruction symptoms, the patient was placed on bed rest under close observation.
The mass decreased in size spontaneously over the 10 days following symptom onset, accompanied by overall clinical improvement. The patient was diagnosed with a posterior mediastinal hematoma.
This is the first reported case of posterior mediastinal hematoma caused by a neck hyperextension injury secondary to a simple fall in a patient with normal coagulation. The outcome was good; however, emergency physicians should be aware that hematomas necessitating airway management may occur after a fall.
一名77岁女性在从站立高度摔倒后出现颈部肿胀和吞咽疼痛。她没有使用抗血小板或抗凝药物的病史。胸部计算机断层扫描显示双侧颈动脉间隙、咽后间隙和后纵隔有等密度至低密度软组织肿块。由于没有气道梗阻症状，患者卧床休息并接受密切观察。
症状出现后的10天内，肿块大小自发缩小，同时整体临床状况有所改善。患者被诊断为后纵隔血肿。
这是首例因单纯摔倒导致颈部过伸损伤引起的后纵隔血肿的报告病例，该患者凝血功能正常。结果良好；然而，急诊医生应意识到摔倒后可能会出现需要进行气道管理的血肿。
