Spontaneous Cervical Hemorrhage - Case Report

Spontaneous cervical hemorrhage is a rare emergency with the common clinical manifestations of acute throat discomfort, neck swelling, difficulty in swallowing, or hoarseness. Endotracheal intubation may be indicated if airway obstruction occurs to prevent life-threatening complication. Identifiable etiologies such as use of anticoagulant or antiplatelet, bleeding diathesis related to underlying diseases, thyroid or parathyroid tumor, vascular malformation or rupture, prior operation, or head and neck trauma have been reported. Subsequent surgical exploration and repair of the ruptured vessel in addition to correction of identifiable etiologies facilitate the recovery. We report a case of spontaneous cervical hemorrhage in an 89-year-old woman with odynophagia and lumping sensation over throat after vigorous coughing for one day. Flexible nasopharyngoscopy revealed hematoma over left oropharynx with extension downwardly to pharynx. Endotracheal intubation was performed due to subsequent progression of the hematoma to the contralateral side. Images of the computed tomography confirmed involvement of the parapharyngeal and retropharyngeal space without extravasation of the contrast media. Angiography with trans-arterial embolization or surgical exploration was not feasible owing to her impaired renal function and advanced age. The response to conservative medical treatment was good with the hematoma subsided dramatically and she was discharged without complication after total recovery. Early identification of spontaneous cervical hemorrhage and regular monitoring of the airway with flexible nasopharyngoscopy are crucial to prevent life-threatening airway obstruction. Exploration of possible etiologies benefits further management decision making. Either conservative treatment, endovascular intervention, or surgical exploration can successfully solve the condition and save life.

關鍵字

spontaneous cervical hemorrhage ； airway obstruction

並列摘要

自發性頸部出血是一種罕見的急症，臨床常見表現為急性咽喉不適、頸部腫脹、吞嚥困難或聲音嘶啞。如果發生氣道阻塞可能需要氣管內管插管以防止危及生命的併發症。使用抗凝劑或抗血小板劑、與原有疾病相關的出血素質、甲狀腺或甲狀旁腺腫瘤、血管畸形或破裂、既往手術史或頭頸部外傷等均為可識別的病因。除了矯正識別出的病因外，隨後的手術探查和破裂血管的修復亦有助於復原。本案例為89歲女性在劇烈咳嗽1天後發生吞嚥痛和喉嚨腫塊感。軟式鼻咽內視鏡檢查顯示左口咽部有血腫，並向下延伸至咽部。由於之後血腫進展至對側故給予了氣管內管插管。電腦斷層掃描影像證實有咽旁和咽後間隙受影響，但沒有造影劑外滲。由於病患腎功能受損和高齡，血管造影經動脈栓塞並不合適、而全身麻醉風險高且手術探查仍有可能無法找到出血來源，故治療上均未採用。經給予保守藥物治療後反應良好血腫明顯消退，痊癒後無併發症順利出院。早期發現自發性頸部出血並定期用軟式鼻咽軟鏡監測氣道對於預防危及生命的氣道阻塞至關重要。探索可能的病因有助於進一步的治療決策選擇；但無論是保守治療、血管內介入栓塞止血還是手術探查，都能成功解決病況，挽救生命。

並列關鍵字

spontaneous cervical hemorrhage ； airway obstruction（自發性頸部出血；呼吸道阻塞）

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