title: [Progressive hematoma in anterior neck after endovascular treatment of middle cerebral artery aneurysm].
abstract: BACKGROUND
  Cervical hematomas can lead to airway compromise, a life threatening condition, regardless of the cause. The following case is the first presentation of cervical hematoma as a complication of endovascular treatment of middle cerebral artery aneurysm.
  
  
  METHODS
  A 49 year-old woman was scheduled for stent placement under general anesthesia for middle cerebral artery aneurysm. Few days before intervention, acetyl salicylic acid and clopidogrel treatment was started. Following standard monitoring and anesthesia induction, the patient's trachea was intubated with a 7.5mm endotracheal tube and the procedure was completed without any complications. Three hours later, dyspnea developed and physical examination revealed progressive swelling and stiffness in the neck. Endotracheal intubation was performed with a 6mm diameter uncuffed tube with the aid of sedation. The vocal cords were completely closed due to compression. There was no leak around the endotracheal tube. The rapidly performed computerized tomography scans showed an enormous hematoma around the neck and extravasation of contrast medium through superior thyroid artery. After coil embolization of superior thyroid artery, she was taken to the intensive care unit as intubated and sedated. Surgical exploration of the hematoma was not recommended by the surgeons, because she was on clopidogrel. After two days, the patient's trachea was extubated safely ensuring that the swelling was sufficiently ceased and leak detected around the endotracheal tube.
  
  
  CONCLUSIONS
  Securing the airway rapidly by endotracheal intubation is the most crucial point in the management of cervical hematomas. Diagnostic and therapeutic procedures should be performed only afterwards.
authors.affiliation: Hacettepe University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Ankara, Turquia. Electronic address: aysunankay@hotmail.com.
authors.forename: Aysun
authors.initials: A
authors.lastname: Ankay Yilbas
authors.affiliation: Hacettepe University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Ankara, Turquia.
authors.forename: Cigdem
authors.initials: C
authors.lastname: Kanburoglu
authors.affiliation: Hacettepe University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Ankara, Turquia.
authors.forename: Filiz
authors.initials: F
authors.lastname: Uzumcugil
authors.affiliation: Hacettepe University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Ankara, Turquia.
authors.forename: Coskun
authors.initials: C
authors.lastname: Cifci
authors.affiliation: Hacettepe University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Ankara, Turquia.
authors.forename: Ozge Ozen
authors.initials: OO
authors.lastname: Saralp
authors.affiliation: Hacettepe University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Ankara, Turquia.
authors.forename: Heves
authors.initials: H
authors.lastname: Karagoz
authors.affiliation: Hacettepe University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Ankara, Turquia.
authors.forename: Seda Banu
authors.initials: SB
authors.lastname: Akinci
authors.affiliation: Hacettepe University, Faculty of Medicine, Department of Radiology, Ankara, Turquia.
authors.forename: Anil
authors.initials: A
authors.lastname: Arat
mesh_terms: D018450:Disease Progression; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D006406:Hematoma / Q000209:etiology*; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008875:Middle Aged; D009333:Neck; D011183:Postoperative Complications / Q000209:etiology*
keywords: Airway obstruction; Aneurysm endovascular treatment; Artéria tireoidea superior; Cervical hemorrhage; Hemorragia cervical; Obstrução das vias aéreas; Superior thyroid artery; Tratamento endovascular de aneurisma