title: A 92-year-old man with retropharyngeal hematoma caused by an injury of the anterior longitudinal ligament.
abstract: Traumatic retropharyngeal hematoma is a rare condition and may be lethal in some cases. In patients with this condition, the absence of a vertebral fracture or a major vascular injury is extremely rare. We present the case of a 92-year-old man who hit his forehead by slipping on the floor in his house. He had no symptoms at the time; however, he experienced throat pain and dyspnea at 6 hours after the injury. On arrival, he complained of severe dyspnea; therefore, an emergency endotracheal intubation was performed. A lateral neck roentgenogram after intubation showed dilatation of the retropharyngeal and retrotracheal space and no evidence of a cervical vertebral fracture. Cervical computed tomography (CT) with contrast medium revealed a massive hematoma extending from the retropharyngeal to the superior mediastinal space but no evidence of contrast medium extravasation or a vertebral fracture. However, sagittal magnetic resonance imaging (MRI) revealed an anterior longitudinal ligament (C4-5 levels) injury. We determined that the cause of the hematoma was an anterior longitudinal ligament injury and a minor vascular injury around the injured ligament. Therefore, we recommend that patients with retropharyngeal hematoma undergo sagittal cervical MRI when roentgenography and CT reveal no evidence of injury.
authors.affiliation: Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Shimokasuya Isehara-City Kanagawa, Japan. morita@is.icc.u-tokai.ac.jp
authors.forename: Seiji
authors.initials: S
authors.lastname: Morita
authors.forename: Shinichi
authors.initials: S
authors.lastname: Iizuka
authors.forename: Haruna
authors.initials: H
authors.lastname: Hirakawa
authors.forename: Shigeo
authors.initials: S
authors.lastname: Higami
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamagiwa
authors.forename: Sadaki
authors.initials: S
authors.lastname: Inokuchi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006406:Hematoma / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D017846:Longitudinal Ligaments / Q000293:injuries*; D008279:Magnetic Resonance Imaging; D008297:Male; D010608:Pharyngeal Diseases / Q000175:diagnosis / Q000209:etiology*; D014057:Tomography, X-Ray Computed