A Systematic Review Reveals Critical Insights into the Condition
Retropharyngeal hematoma (RH) is a rare but potentially life-threatening condition that can cause acute airway obstruction. A recent systematic review published in the Saudi Medical Journal has shed light on the mechanisms of injury, clinical manifestations, radiological findings, management, and outcomes associated with this condition. The study with DOI: 10.15537/smj.2024.45.1.20230565, carried out in accordance with the Preferred Reporting Items of Systematic Reviews guidelines, is a critical piece of literature for clinicians dealing with head, neck, and spinal injuries.
Epidemiology and Risk Factors
The research, spearheaded by Alabdulqader and colleagues, included the analysis of 56 articles published between 1988 and 2022. The findings revealed that the majority of patients with traumatic RH were male (69.7%), with more than half being over the mean age of 61.7 years. Elderly patients are therefore at a higher risk, primarily due to a relative increase in falls, which constituted 54.5% of the injury mechanisms.
Symptoms and Diagnosis
The most prevalent symptom associated with RH was dyspnea, experienced by 66.6% of patients, typically presenting within the first 24 hours post-injury. Accurate and timely diagnosis is crucial considering cervical vertebral fractures were identified as a leading cause. Computed tomography was the most common imaging modality used, with retropharyngeal (38%) and prevertebral (15%) hematoma being frequently reported findings. In some cases, magnetic resonance imaging (MRI) was pivotal in revealing retropharyngeal mass lesions.
Management Strategies
Treatment of RH varies, but over 50% of the cases were managed by observation alone (44 cases). When intervention was necessary, endotracheal intubation emerged as the most commonly employed method for airway management (n=35). Notably, 90.9% of the patients were not on anticoagulants or afflicted with coagulation disorders, suggesting that the presence of these factors is not required for the development of RH following trauma.
Outcomes and Complications
The review highlights traumatic RH often results from falls, and dyspnea is the primary symptom. While observation is the prevalent treatment approach, there are instances where significant intervention, including endotracheal intubation, is required. The outcomes largely depend on the promptness of diagnosis and the appropriateness of the management strategy.
Critical Cases from Literature
This review builds on previously documented evidence, citing cases like those compiled by Karmacharya et al. (2015), which focused on upper airway hematoma secondary to warfarin therapy, and Tsao et al. (2021), who retrospectively analyzed blunt traumatic retropharyngeal hematoma cases presenting with respiratory symptoms.
Conclusion
Traumatic RH, while not common, poses a significant risk due to its potential for rapid onset of airway obstruction. It is therefore essential for clinicians to be familiar with its presentation and management, particularly in elderly patients who have suffered from falls.
Keywords
1. Retropharyngeal hematoma
2. Airway obstruction
3. Trauma and falls in elderly
4. Endotracheal intubation
5. Spinal fracture and hematoma
References
1. Karmacharya, P., Pathak, R., Ghimire, S., Shrestha, P., Ghimire, S., Poudel, D.R., et al. (2015). Upper airway hematoma secondary to warfarin therapy: a systematic review of reported cases. North American Journal of Medical Sciences, 7(11), 494-502. DOI: 10.4103/1947-2714.170625. PMID: 26713297. PMCID: PMC4683804.
2. Tsao, Y.L., Hsu, C.C., & Chen, K.T. (2021). Blunt traumatic retropharyngeal hematoma with respiratory symptoms: a systematic review of reported cases. Emergency Medicine International, 2021, 5158403. DOI: 10.1155/2021/5158403. PMID: 34659833. PMCID: PMC8516559.
3. Sandooram, D., Chandramohan, A.R., & Radcliffe, G. (2000). Retropharyngeal haematoma causing airway obstruction: a multidisciplinary challenge. The Journal of Laryngology & Otology, 114(9), 706-708. DOI: 10.1258/0022215001906063. PMID: 11091836.
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