title: Life-Threatening Retropharyngeal Hemorrhage Secondary to Rupture of the Inferior Thyroid Artery.
abstract: Inferior thyroid artery (ITA) rupture is rare and may progress to life-threatening conditions. We present a patient who visited the emergency department after an episode of syncope and dizziness in which he had a mechanical fall that resulted in abrasions and a hematoma to his left forehead. The patient presented with dysphagia and anterior neck swelling that progressed rapidly into airway compromise requiring endotracheal intubation. Emergent computed tomography revealed a large retropharyngeal hematoma, with active arterial extravasation that was thought to be arising from the thyrocervical trunk on the left. The hematoma measured approximately 6.7 cm transversely and 3.2 cm anteroposteriorly and extended from the level of the lower nasopharynx, down the neck into the retropharyngeal and danger space and into the mediastinum posterior to the esophagus, overall approximately 25 cm. The larynx was deviated anteriorly and there was esophageal compression. An emergent arteriogram and catheterization confirmed bleeding from branches of the ITA, and successful embolization was performed. It is important to recognize the ITA rupture as a potential etiology of an acute airway compromise. In emergent situations, while securing an airway is a priority, rapidly initiating diagnostic testing to confirm the diagnosis and arranging for arterial embolization can be life-saving.
authors.affiliation: Department of Emergency Medicine, Lehigh Valley Hospital and Health Network, USF MCOM, CC & I-78, Allentown, PA 18103, USA.
authors.forename: Cristina G
authors.initials: CG
authors.lastname: Calogero
authors.affiliation: Department of Emergency Medicine, Lehigh Valley Hospital and Health Network, USF MCOM, CC & I-78, Allentown, PA 18103, USA.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Miller
authors.affiliation: Department of Emergency Medicine, Lehigh Valley Hospital and Health Network, USF MCOM, CC & I-78, Allentown, PA 18103, USA.
authors.forename: Marna Rayl
authors.initials: MR
authors.lastname: Greenberg
references.citation: J Visc Surg. 2011 Jun;148(3):e227-8
references.pmid: 21727055
references.citation: Eur Radiol. 2001;11(7):1285-6
references.pmid: 11471625
references.citation: Eur J Emerg Med. 2002 Jun;9(2):159-61
references.pmid: 12131640
references.citation: J Vasc Surg. 1987 Aug;6(2):194-6
references.pmid: 3612969
references.citation: Am J Emerg Med. 2015 Aug;33(8):1115.e1-3
references.pmid: 25770593
references.citation: AJNR Am J Neuroradiol. 2001 Jun-Jul;22(6):1209-11
references.pmid: 11415922
references.citation: J Vasc Surg. 2005 Dec;42(6):1226-9
references.pmid: 16376220
references.citation: Interact Cardiovasc Thorac Surg. 2010 Aug;11(2):209-10
references.pmid: 20442206
references.citation: Postgrad Med J. 1994 Jun;70(824):452-4
references.pmid: 8029169
references.citation: BMC Anesthesiol. 2007 Mar 12;7:2
references.pmid: 17352800