Fox Elliott C, Manchala Venkata
Frank H. Netter MD School of Medicine, Quinnipiac University, Hamden, CT, USA.
Department of Medicine, St. Vincent's Medical Center, Bridgeport, CT, USA.
Am J Case Rep. 2018 Aug 17;19:969-972. doi: 10.12659/AJCR.909502.
BACKGROUND Retropharyngeal hematoma is a relatively rare diagnosis that requires a high clinical suspicion and stabilization of the airway to prevent rapid deterioration. We report a case of a spontaneous retropharyngeal hematoma in an elderly patient with myelodysplastic syndrome and associated thrombocytopenia. CASE REPORT A 90-year-old man with myelodysplastic syndrome was brought to the Emergency Department with complaints of difficulty swallowing and muffled voice for 24 hours. Upon arrival, his vital signs and physical exam were unremarkable, except that when he was asked to take a sip of water, he could not swallow it. Complete blood count was remarkable for leukocytosis of 14.3×10³/mcL, hemoglobin of 9.0 gm/dL, and platelet count of 26×10³/mcL. Chest X-ray and lateral soft-tissue neck X-rays were grossly unremarkable. The patient was admitted for further evaluation and was scheduled for esophagogastroduodenoscopy. During intubation for esophagogastroduodenoscopy, the patient was noted to have significant airway narrowing. A subsequent CT scan revealed a 3×2×2 cm supraglottic hypodensity, thought to represent a retropharyngeal hematoma. The patient was transferred to the Intensive Care Unit (ICU) and received platelet transfusions. The ICU course was complicated by anemia, which necessitated transfusion of packed red blood cells. On hospital day 7, the patient reported resolution of his symptoms and was discharged home. CONCLUSIONS This case adds to the growing body of literature on spontaneous retropharyngeal hematomas. High clinical suspicion is warranted in patients who present with acute dysphagia, odynophagia, and dysphonia. Prompt imaging and airway management are vital in managing patients with this condition.
咽后血肿是一种相对罕见的诊断，需要高度的临床怀疑并稳定气道以防止病情迅速恶化。我们报告一例老年骨髓增生异常综合征合并血小板减少症患者发生的自发性咽后血肿病例。病例报告：一名90岁患有骨髓增生异常综合征的男性因吞咽困难和声音嘶哑24小时被送至急诊科。入院时，他的生命体征和体格检查无异常，只是当被要求喝一小口水时，他无法吞咽。全血细胞计数显示白细胞增多，为14.3×10³/微升，血红蛋白为9.0克/分升，血小板计数为26×10³/微升。胸部X线和颈部软组织侧位X线大致正常。患者入院进一步评估，并计划进行食管胃十二指肠镜检查。在进行食管胃十二指肠镜检查插管时，发现患者气道明显狭窄。随后的CT扫描显示声门上低密度区大小为3×2×2厘米，考虑为咽后血肿。患者被转至重症监护病房（ICU）并接受了血小板输注。ICU病程中出现贫血并发症，需要输注浓缩红细胞。住院第7天，患者报告症状缓解并出院回家。结论：本病例增加了关于自发性咽后血肿的文献数量。对于出现急性吞咽困难、吞咽痛和声音嘶哑的患者，有必要保持高度的临床怀疑。及时的影像学检查和气道管理对于治疗此类患者至关重要。
