Patel Shaneil V, Reza Abbas, Rice Scott R
Speciality Trainee in Clinical Radiology, East of England Imaging Academy, The Cotman Centre, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
Speciality Trainee in Clinical Radiology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK.
BJR Case Rep. 2021 Apr 21;7(3):20200190. doi: 10.1259/bjrcr.20200190. eCollection 2021 May 1.
Delayed life-threatening airway obstruction due to venous injury following blunt, non-penetrative trauma to the neck. A rare case of rapid force, blunt trauma by closing train carriage doors, leading to injury to the left internal jugular vein, subsequent retropharyngeal haematoma and airway obstruction. There was a significant delay of a few hours between injury and acute deterioration. Initial dual phase CT (unenhanced and arterial) studies identified the large retropharyngeal haematoma but the assessment of the source was inconclusive likely due to the venous injury becoming compressed by the swelling/haematoma at the time of investigation. Subsequent triple phase (unenhanced, arterial and venous) studies were performed identifying a flap in the left internal jugular vein as the likely site of vascular injury. A venous origin of haemorrhage supported the patients delayed onset of symptoms following the injury. We suggest with blunt force trauma to the neck, in the context of suspicion of haematoma and airway compromise, the radiologist should consider protocolling a triple phase (unenhanced, arterial and venous) angiographic study.
钝性非穿透性颈部创伤后因静脉损伤导致的延迟性危及生命的气道梗阻。这是一例罕见的因快速用力、被关闭的火车车厢门造成钝性创伤，导致左颈内静脉损伤、随后出现咽后血肿和气道梗阻的病例。损伤与急性病情恶化之间有长达数小时的显著延迟。最初的双期CT（平扫和动脉期）检查发现了巨大的咽后血肿，但由于在检查时静脉损伤被肿胀/血肿压迫，对出血源的评估尚无定论。随后进行了三期（平扫、动脉期和静脉期）检查，确定左颈内静脉的一个瓣片为可能的血管损伤部位。出血源于静脉支持了患者受伤后症状延迟出现的情况。我们建议，对于颈部钝性暴力创伤，在怀疑有血肿和气道受压的情况下，放射科医生应考虑安排三期（平扫、动脉期和静脉期）血管造影检查。
