Department of Emergency Medicine, Japanese Red Cross Ishinomaki Hospital, Miyagi, Japan.
Department of Emergency Medicine, Japanese Red Cross Ishinomaki Hospital, Miyagi, Japan.
Am J Emerg Med. 2021 Aug;46:799.e3-799.e4. doi: 10.1016/j.ajem.2021.01.087. Epub 2021 Feb 2.
Retropharyngeal hematoma is a potentially life-threatening condition because it can easily lead to airway obstruction. Most of the previously reported cases of retropharyngeal hematoma are caused by predisposing factors such as head and neck trauma, the use of anticoagulants, or the presence of underlying bleeding diathesis. Herein, we report a case of retropharyngeal hematoma in a patient with chronic alcoholism, where we could not confirm any predisposing factors at the time of examination. A 61-year-old man with chronic alcoholism presented to our emergency department with convulsive seizures. He was diagnosed with alcohol withdrawal and transferred to a secondary hospital after the seizure resolved. However, a few hours later, he returned to our department with a persistent cough and complained of pain and swelling in the neck. One hour later, he suddenly developed dyspnea; therefore, emergency intubation was performed. Although initially computed tomography (CT) showed normal findings, contrast-enhanced CT revealed a retropharyngeal hematoma. He was managed conservatively and transferred to a specialty hospital for intensive care. Chronic alcoholism may be a predisposing factor for retropharyngeal hematoma due to the high incidence of head trauma, neck hyperextension by convulsion, and hemostatic disorders. However, taking an accurate patient history is sometimes difficult because of the effects of intoxication or alcohol withdrawal. If a patient with chronic alcoholism presents with symptoms of airway compression, then a retropharyngeal hematoma should be suspected, and emergency intubation should be considered.
咽后血肿是一种潜在的危及生命的疾病，因为它很容易导致气道阻塞。大多数先前报道的咽后血肿病例是由头颈部外伤、使用抗凝剂或存在潜在出血素质等诱发因素引起的。在此，我们报告一例慢性酒精中毒患者的咽后血肿病例，在检查时我们无法确定任何诱发因素。一名 61 岁的慢性酒精中毒男性因抽搐发作到我院急诊科就诊。他被诊断为酒精戒断，并在抽搐缓解后转至二级医院。然而，几个小时后，他因持续咳嗽和颈部疼痛肿胀回到我们科室。1 小时后，他突然出现呼吸困难；因此，紧急进行了气管插管。尽管最初的计算机断层扫描（CT）显示正常，但增强 CT 显示咽后血肿。他接受了保守治疗，并转至专科医院进行重症监护。慢性酒精中毒可能是咽后血肿的一个诱发因素，因为其头部外伤、抽搐时颈部过度伸展和止血障碍的发生率较高。然而，由于中毒或酒精戒断的影响，有时难以准确询问患者的病史。如果慢性酒精中毒患者出现气道压迫的症状，则应怀疑咽后血肿，并应考虑紧急气管插管。
