[Dyspnea caused by spontaneous hematoma of the oropharynx and larynx during marcumar therapy].
A patient with a history of tachycardiac atrial fibrillation and pulmonary embolism was admitted to the emergency unit with acute shortness of breath. The patient was on coumarin medication. Pulmonary embolism, heart failure, or pulmonary edema could be ruled out. Laryngoscopy revealed a huge hematoma of both valleculae extending to the lateral pharyngeal wall and the epiglottis. The epiglottic cartilage was displaced to the posterior pharyngeal wall. The INR was > 6. Prothrombin complex, vitamin K1, corticoids, and fresh frozen plasma were administered immediately. The patient was monitored--without tracheotomy--in the intensive care unit and received oxygen. In a patient with dyspnea, impaired ventilation has to be considered besides impaired perfusion or diffusion.
Götte
K
K
Universitäts-Hals-Nasen-Ohrenklinik, Universitätsklinikum Mannheim, Postfach, 68135 Mannheim. karl.goette@hno.ma.uni-heidelberg.de
Hörmann
K
K
D000368:Aged; D000402:Airway Obstruction / Q000139:chemically induced / Q000175:diagnosis; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000139:chemically induced*; D006406:Hematoma / Q000139:chemically induced* / Q000175:diagnosis; D006801:Humans; D007828:Laryngoscopy; D008297:Male; D009960:Oropharynx; D010644:Phenprocoumon / Q000009:adverse effects* / Q000627:therapeutic use; D011655:Pulmonary Embolism / Q000188:drug therapy*
D010644:Phenprocoumon