Mind the gap: life-threatening retropharyngeal haematoma resulting in acute airway obstruction following blunt trauma by closing train carriage doors

Traumatic retropharyngeal hematoma: A systematic review of reported cases

OBJECTIVES

To study the mechanisms of injury, clinical manifestations, radiological findings, management, and outcomes of traumatic retropharyngeal hematoma (RH).

METHODS

We used the Preferred Reporting Items of Systematic Reviews guidelines to carry out a systematic literature review to identify all published cases of traumatic RH by searching the PubMed database. Articles published between 1988 and 2022 that reported traumatic RH were included. However, articles that reported non-traumatic RHs and non-English articles were excluded from this study.

RESULTS

Of the 62 articles screened, 56 were included. Most patients (55%) were above the mean age of 61.7. The majority of patients were male (69.7%). The main symptom was dyspnea (66.6%) and symptoms usually presented within 24 hours. Among the patients, 90.9% did not take anticoagulants or have coagulation disorders, and the main injury mechanism was falling (54.5%). Most of the computed tomography findings reported retropharyngeal (38%) and prevertebral (15%) hematoma. Meanwhile, magnetic resonance imaging revealed 2 masses in the retropharyngeal space and 2 RHs. With several treatment modalities, more than 50% of the cases were only observed (44 cases), and endotracheal intubation was the most commonly used airway management method (n=35).

CONCLUSION

Traumatic RH is often caused by falls, particularly in elderly patients. Dyspnea is the primary symptom, usually appearing within 24 hours. Cervical vertebral fractures are the leading cause, and observation is the most common treatment approach.PROSPERO Reg. No.: CRD42022349010.